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lecture 12

Total questions: 42

Worksheet time: 21mins

Name
Class
Date
1.

Which of the following represents a benign epithelial odontogenic tumour derived primarily from odontogenic epithelium?

a)

Odontogenic fibroma

b)

Ameloblastoma

c)

Cemento-ossifying fibroma

d)

Odontome

e)

Odontogenic myxoma

2.

Which tissue origin best explains the development of odontogenic myxoma?

a)

A. Dental lamina

b)

B. Dental follicle

c)

C. Reduced enamel epithelium

d)

D. Rests of Serres

e)

E. Rests of Malassez

3.

According to the WHO simplified classification, which of the following is categorised under benign mixed epithelial and mesenchymal odontogenic tumours?

a)

Ameloblastoma

b)

Odontogenic fibroma

c)

Dentinogenic ghost cell tumour

d)

Cementoblastoma

e)

Clear cell odontogenic carcinoma

4.

A 28-year-old woman presents with a painless swelling in the posterior mandible. Radiographs show a multilocular radiolucent lesion. Biopsy reveals epithelial islands resembling ameloblasts with stellate reticulum-like cells in a dense fibrous stroma. Which classification does this lesion belong to according to the WHO system?

a)

Benign mesenchymal tumour

b)

Benign mixed epithelial and mesenchymal tumour

c)

Benign epithelial odontogenic tumour

d)

Fibro-osseous lesion

e)

Malignant odontogenic neoplasm

5.

Which of the following best reflects the most common clinical site for a conventional ameloblastoma?

a)

Anterior maxilla

b)

Posterior mandible

c)

Anterior mandible

d)

Posterior maxilla

e)

Midline of the palate

6.

Why do ameloblastomas frequently appear multilocular on radiographs?

a)

Presence of multiple cystic spaces within the tumor

b)

Dense calcifications forming a honeycomb pattern

c)

Infiltration into surrounding soft tissues

d)

High vascularity causing radiographic anomalies

e)

Associated with ghost cells

7.

Which histopathological feature is characteristic of conventional ameloblastoma?

a)

Odontogenic epithelium resembling a glandular pattern

b)

Palisading columnar basal cells with reversed polarity

c)

Dense fibrous stroma with absence of stellate reticulum like cells

d)

Cellular atypia with hyperchromatic nuclei

e)

Dentin-like material in the stroma

8.

Which management approach is considered the standard of care for a conventional ameloblastoma involving the posterior mandible?

a)

Marsupialisation and long-term observation

b)

Incision and drainage followed by antibiotics

c)

Simple enucleation without peripheral curettage

d)

Wide surgical excision with 10 mm bone margins

e)

Enucleation with decompression over several months

9.

Which radiographic description most strongly suggests a conventional solid ameloblastoma?

a)

Unilocular radiolucency with sclerotic margin around an impacted canine

b)

Ill-defined radiolucency with sunburst periosteal reaction

c)

Multilocular radiolucency with “soap-bubble” or “honeycomb” pattern

d)

Ground-glass radiopacity with expansion

e)

Cotton-wool opacity involving multiple quadrants

10.

Which histological pattern of conventional ameloblastoma is characterised by epithelial islands with a peripheral layer of tall columnar cells showing reversed polarity?

a)

Plexiform

b)

Basal cell

c)

Granular cell

d)

Follicular

e)

Acanthomatous

11.

Which mutation has been identified in most ameloblastomas and activates the MAP kinase pathway?

a)

KRAS mutation

b)

PTCH gene mutation

c)

TP53 mutation

d)

BRAF V600E mutation

e)

CDKN2A mutation

12.

A 42-year-old patient presents with a painless swelling in the posterior mandible. Radiographs reveal a well-defined multilocular radiolucency causing buccal and lingual expansion. Biopsy shows epithelial islands with reversed polarity of basal cells and central stellate reticulum-like areas. Which diagnosis best fits these findings?

a)

Odontogenic keratocyst

b)

Giant-cell granuloma

c)

Odontogenic myxoma

d)

Conventional ameloblastoma

e)

Central mucoepidermoid carcinoma

13.

Which feature best distinguishes desmoplastic ameloblastoma from the conventional type?

a)

Numerous large cystic spaces

b)

Sparse epithelial islands within dense collagenous stroma

c)

Abundant stellate reticulum-like cells

d)

Pronounced ameloblast-like peripheral columnar cells

e)

Frequent mitotic figures

14.

A 40-year-old patient presents with a radiolucent lesion in the anterior maxilla showing a fine honeycomb pattern. Biopsy reveals sparse epithelial islands in a densely collagenous background with no obvious ameloblast-like cells. Which diagnosis best matches these findings?

a)

Odontogenic myxoma

b)

Desmoplastic ameloblastoma

c)

Fibrous dysplasia

d)

Calcifying epithelial odontogenic tumour

e)

Squamous odontogenic tumour

15.

Which feature best explains why metastasising ameloblastoma is not considered truly malignant?

a)

It shows extensive nuclear atypia

b)

It frequently transforms into carcinoma

c)

Its metastases are histologically identical to benign ameloblastoma

d)

The tumour arises only in the mandible

e)

It rapidly causes neurological symptoms

16.

A patient previously treated surgically for a mandibular ameloblastoma now presents with multiple pulmonary nodules. Biopsy of a lung lesion shows epithelial islands identical to those in the original tumour, without atypia or mitotic activity. Which explanation best fits this phenomenon?

a)

True malignant transformation of the primary tumour

b)

Development of primary lung carcinoma unrelated to the jaw lesion

c)

Implantation metastasis resulting from previous surgery

d)

Odontogenic cyst remnants in the lung

e)

High-grade sarcomatous change in the tumour stroma

17.

Which variant of unicystic ameloblastoma shows papillary projections into the cyst lumen without tumour islands infiltrating the wall?

a)

Luminal

b)

Mural

c)

Intraluminal (plexiform unicystic)

d)

Acanthomatous

e)

Follicular

18.

A 22-year-old male presents with a painless swelling near the angle of the mandible. Radiographs show a unilocular radiolucency associated with an unerupted molar. Biopsy reveals a cystic lesion lined by ameloblast-like cells. What is the most likely diagnosis?

a)

Follicular keratocyst

b)

Dentigerous cyst

c)

Unicystic ameloblastoma

d)

Ameloblastic fibroma

e)

Eruption cyst

19.

A 19-year-old presents with a unilocular radiolucency around an unerupted mandibular third molar. Biopsy shows a cyst lined by ameloblastomatous epithelium limited to a single layer with no wall infiltration. Ameloblast-like cells confined to the cyst lining. Which subtype best corresponds to this lesion?

a)

Mural

b)

Luminal

c)

Solid

d)

Intramural

e)

Intraluminal

20.

Why is the mural subtype of unicystic ameloblastoma more aggressive?

a)

Ghost cells extend into surrounding bone.

b)

Tumor islands infiltrate the fibrous cyst wall.

c)

Calcifications form within the cyst wall.

d)

Increased mitotic activity in epithelial cells.

e)

Prominent vascularity enhances tumor growth.

21.

What is a characteristic histological feature of calcifying epithelial odontogenic tumor?

a)

Sheets of eosinophilic cells, pink-staining amyloid with Liesegang rings

b)

Palisaded ameloblast-like cells with reversed polarity

c)

Ghost cells in the stroma

d)

Rounded islands of squamous epithelium

e)

Fibrous stroma with myxoid ground substance

22.

A 48-year-old patient is found to have a well-defined mixed radiolucent–radiopaque lesion in the posterior mandible. Histology shows eosinophilic epithelial cells with intercellular bridges, nuclear pleomorphism, and areas of amyloid exhibiting concentric calcifications. Which diagnosis best fits these findings?

a)

Ameloblastoma

b)

Calcifying epithelial odontogenic tumour

c)

Odontogenic myxoma

d)

Squamous odontogenic tumour

e)

Cementoblastoma

23.

Which microscopic feature of calcifying epithelial odontogenic tumour most often leads to confusion with carcinoma?

a)

Dense collagenous stroma

b)

Hyperkeratinised epithelium

c)

Nuclear hyperchromatism and size variation

d)

Abundant mitotic figures

e)

Clear cell change

24.

Which histological feature is characteristic of squamous odontogenic tumor?

a)

A. Palisaded columnar cells

b)

B. Rounded islands of squamous epithelium without peripheral palisading

c)

C. Multinucleated giant cells

d)

D. Dentin-like material in the stroma

e)

E. Ghost cells

25.

A 17-year-old female presents with a slow-growing, asymptomatic swelling in the anterior maxilla around an unerupted canine. Radiographs show a well-defined radiolucency resembling a dentigerous cyst with faint speckled calcifications. Which diagnosis best fits these features?

a)

Odontogenic myxoma

b)

Calcifying epithelial odontogenic tumour

c)

Adenomatoid odontogenic tumour

d)

Dentigerous cyst with dystrophic calcification

e)

Ameloblastic fibroma

26.

Which microscopic feature most strongly supports a diagnosis of adenomatoid odontogenic tumour?

a)

Duct-like structures lined by columnar cells

b)

Rounded squamous epithelial islands

c)

Calcified ghost cells

d)

Sheets of eosinophilic cells

e)

Multinucleated giant cells

27.

What is a common radiographic feature of adenomatoid odontogenic tumor?

a)

Multilocular radiolucency

b)

Unilocular radiolucency with fine speckled calcifications

c)

Dense sclerotic lesion with a radiolucent border

d)

Soap-bubble appearance

e)

Target-like radiopacity

28.

Which age group is most commonly affected by ameloblastic fibroma?

a)

Infants under 2 years

b)

Adults between 30–50 years

c)

Patients aged 7–20 years

d)

Elderly over 70 years

e)

First decade only

29.

Which microscopic feature most strongly supports the diagnosis of ameloblastic fibroma?

a)

Sheets of squamous cells with keratin formation

b)

Dense eosinophilic epithelial cells with amyloid

c)

Cellular mesenchyme resembling dental papilla with epithelial strands

d)

Duct-like structures lined by columnar cells

e)

Large cementum masses fused to a root

30.

Why is ameloblastic fibroma considered a mixed odontogenic tumor?

a)

Both epithelial and mesenchymal components are neoplastic.

b)

It contains mineralized dental tissues like enamel and dentin.

c)

It shows transformation into ameloblastoma histologically.

d)

Both epithelial and stromal components exhibit ghost cell formation.

e)

It arises exclusively in association with unerupted teeth.

31.

A 14-year-old presents with a slowly enlarging posterior mandibular swelling. Radiographs show a unilocular radiolucency displacing an unerupted second molar. Histology reveals epithelial islands with peripheral buds resembling cap-stage tooth germs within cellular mesenchyme. Which diagnosis best fits these findings?

a)

Odontogenic myxoma

b)

Adenomatoid odontogenic tumour

c)

Ameloblastic fibroma

d)

Dentigerous cyst

e)

Ameloblastoma

32.

Which statement best describes ameloblastic fibro-odontoma?

a)

It forms enamel only and is a true neoplasm

b)

It forms dentine only and behaves aggressively

c)

It produces both enamel and dentine and represents a developing odontoma

d)

It is a variant of ameloblastoma with calcifications

e)

It is identical to ameloblastic fibroma histologically

33.

Which radiographic appearance most commonly describes primordial odontogenic tumour?

a)

Multiple radiopaque masses resembling osteoma

b)

Large expanding radiolucency in the posterior mandible

c)

Soap-bubble multilocularity extending to the ramus

d)

Scalloped radiolucency between roots

e)

Mixed radiolucent-radiopaque lesion with Liesegang rings

34.

A 12-year-old presents with a large unilocular radiolucent lesion in the posterior mandible associated with an unerupted molar. Histology shows a solid mass of dental papilla-like tissue surrounded by a thin layer of ameloblast-like cells, but no dentine or enamel matrix. Which diagnosis best fits these findings?

a)

Ameloblastic fibrodentinoma

b)

Odontogenic myxoma

c)

Primordial odontogenic tumour

d)

Dentigerous cyst

e)

Ameloblastoma

35.

Which histological feature is seen in primordial odontogenic tumor?

a)

Solid mass of dental papilla-like tissue with ameloblasts

b)

Ghost cells with dystrophic calcification

c)

Loose myxoid stroma with spindle-shaped fibroblasts

d)

Sheets of eosinophilic cells with hyperchromatic nuclei

e)

Woven bone trabeculae in fibrous stroma

36.

Which feature most reliably distinguishes a compound odontome from a complex odontome?

a)

Disorganized dental tissues without tooth-like structures

b)

Well-formed tooth-like structures with enamel, dentin, and pulp

c)

Presence of hyperplastic cementum

d)

Prominent calcifications within ghost cells

e)

Cellular mesenchymal stroma resembling dental papilla

37.

Why is a compound odontome considered a developmental hamartoma rather than a true neoplasm?

a)

It contains normal but disorganized dental tissues.

b)

It arises from mesenchymal components exclusively.

c)

It has no potential for malignant transformation.

d)

It is associated with systemic syndromes like Gardner's syndrome.

e)

It resolves spontaneously in most cases.

38.

Which of the following is a characteristic histological feature of dentinogenic ghost cell tumor?

a)

Ghost cells and dentinoid material in the stroma

b)

Amyloid deposition with concentric calcifications

c)

Palisaded columnar basal cells

d)

Multinucleated giant cells with hemosiderin deposits

e)

Loose, myxoid stroma with spindle-shaped fibroblasts

39.

Which radiographic appearance is most characteristic of a mature complex odontome?

a)

Ground-glass opacity

b)

Multilocular radiolucency

c)

Irregular, densely radiopaque mass

d)

Radiolucency with curved septa

e)

Cotton-wool sclerotic patches

40.

A 9-year-old child presents with delayed eruption of an upper incisor. Radiographs show multiple small radiopaque structures within a single crypt in the anterior maxilla. Which diagnosis best fits these findings?

a)

Complex odontoma

b)

Compound odontoma

c)

Hypercementosis

d)

Dentigerous cyst

e)

Odontogenic fibroma

41.

What radiographic appearance is typically associated with CEOT?

a)

Multilocular radiolucency with a soap-bubble appearance

b)

Mixed radiolucent-radiopaque lesion with a well-defined border

c)

Unilocular radiolucency without calcifications

d)

Moth-eaten appearance with indistinct margins

e)

Target-like radiopacity around tooth roots

42.

A 45-year-old patient presents with a well-demarcated mixed radiolucent–radiopaque lesion in the mandibular body. Histology shows ameloblastoma-like epithelial islands, numerous ghost cells, and deposits of dentinoid. Which diagnosis best fits these findings?

a)

Calcifying odontogenic cyst

b)

Ameloblastoma

c)

Dentinogenic ghost cell tumour

d)

Odontogenic fibroma

e)

Complex odontome