Peripheral odontogenic tumors

Peripheral Adenomatoid Odontogenic Tumor - A Rare Cause of Gingival Enlargement: A Case Report with CBCT Findings

Introduction

Adenomatoid odontogenic tumor (AOT) is an uncommon benign odontogenic lesion with varied clinical and histological presentation. It has slow growth potential and a low recurrence rate. The tumor is mainly seen in females in the second decade of life, predominantly affecting the maxilla and associated most often with unerupted canine teeth, earning the epithet “two-thirds tumor”. There are three variants: intrafollicular, extrafollicular, and peripheral. The peripheral or extra osseous type is a rare form that arises in gingival tissue.

Case Presentation

This article describes a case of AOT in a 10-year-old girl who presented with gingival enlargement in relation to the maxillary left central incisor. Interestingly, intraoral periapical radiography did not show any significant findings. However, cone-beam computed tomography of the site revealed significant bone loss in the area. A surgical excision was done. Histopathological examination revealed features of AOT. Based on clinical, radiographic, and histological evidence, a diagnosis of peripheral AOT (PAOT) was made.

Conclusion

PAOT is a rare disease entity in children that mimics gingival swelling, and may often be misdiagnosed by dentists. With literature still ambiguous on the origin of the tumor and biological course, it becomes imperative to examine any gingival swelling in children with a proper clinical examination, periapical radiography, and if necessary cone-beam computed tomography. Excision and histopathological evaluation will help in confirming the exact disease condition.

Controversies in Odontogenic Tumours: Review

Odontogenic tumours are lesions that occur solely within the oral cavity and are so named because of their origin from the odontogenic (i.e. tooth-forming) apparatus. Odontogenic tumours comprise a variety of lesions ranging from non-neoplastic tissue proliferations to benign or malignant neoplasms. However, controversies exist regarding the pathogenesis, categorisation and clinical and histological variations of these tumours. The recent 2017 World Health Organization classification of odontogenic tumours included new entities such as primordial odontogenic tumours, sclerosing odontogenic carcinomas and odontogenic carcinosarcomas, while eliminating several previously included entities like keratocystic odontogenic tumours and calcifying cystic odonogenic tumours. The aim of the present review article was to discuss controversies and recent concepts regarding odontogenic tumours so as to increase understanding of these lesions.

Angioleiomyoma (Vascular Leiomyoma) of the Oral Cavity

A 70-year-old male presented with a slow growing, dome shaped and painless mass of the hard palate. The mass was excised. Histopathological examination confirmed the diagnosis of a angioleiomyoma (vascular leiomyoma). A leiomyoma is an uncommon benign tumor of smooth muscle differentiation. True leiomyomas of the oral cavity are rare and most oral tumors are derived from the smooth muscle of walls of blood vessels. Therefore, they are called vascular leiomyomas or angioleiomyomas. Clinically, they may resemble a myriad other conditions both benign and malignant. A definitive diagnosis depends upon histopathological examination of the biopsied tissue in correlation with the tumor cell immunohistochemistry. Tumors are excised and recurrence is rare. The histopathological findings and differential diagnosis of a case of a palatal angioleiomyoma are discussed.

A Large Extragnathic Keratocystic Odontogenic Tumour

Odontogenic keratocysts (OKCs) are developmental cysts which occur typically in the jawbones. They present more commonly in the posterior mandible of young adults than the maxilla. OKCs have been reclassified under odontogenic tumours in 2005 by the WHO and have since been termed as keratocystic odontogenic tumours (KCOTs). Here we report a case of a recurrent buccal lesion in a 62-year-old man which was provisionally diagnosed as a space infection (buccal abscess) but surprisingly turned out to be a soft tissue KCOT in an unusual location on histopathologic examination.

Peripheral adenomatoid odontogenic tumour - is it really peripheral?: a case report

A Peripheral Adenomatoid Odontogenic Tumour (PAOT) is quite a rare entity which has been infrequently reported in the literature. These uncommon clinical variants of an Adenomatoid Odontogenic Tumour (AOT), typically manifest as a soft tissue mass of the gingiva, which mimick a common epulis, but yet have an identical histopathologic presentation as their intraosseous counterpart. These lesions, though they are indolent in nature, have a tendency to cause well defined deep bony pockets. Only fourteen cases have been adequately documented so far. We are reporting a case of a PAOT of the anterior maxillary gingiva, with a periodontal bone defect in a 12 year old girl. The relevant literature has been briefly reviewed, with an insight into the probable origin of PAOTs with bony defects.

A retrospective analysis of peripheral odontogenic fibroma in an Iranian population

PURPOSE

The aim of this study was to assess the relative frequency of peripheral odontogenic fibroma (POdF) in an Iranian population and to compare the obtained data with previous reports.

MATERIALS AND METHODS

Archival material was retrospectively analyzed from 1967 to 2007, and all microscopic slides of lesions considered in the differential diagnosis of POdF were retrieved. A diagnosis of POdF was made according to the criteria described by the World Health Organization in 2005. Demographic data, including age, gender, site of involvement, and previous history of POdF, were recorded for all samples with a diagnosis of this neoplasm.

RESULTS

Nineteen POdFs were identified, which accounted for 0.14% of the archival cases. One of these tumors was a recurrence, diagnosed 12 months earlier. All cases were of the epithelium-rich or World Health Organization histologic subtype and most tumors occurred in the mandible. No significant difference in the prevalence of POdF was found between the studied variables. Among the 18 primary neoplasms, follow-up was possible for 2 to 13 years in 6 cases, and none developed recurrence.

CONCLUSION

Similar to previous investigations, this study shows that POdFs are uncommon odontogenic lesions. Detailed information on POdF is limited because of its rarity; therefore, this study may provide additional data for further investigations and may enable better understanding of this tumor.

Peripheral ameloblastic fibroma of the maxilla: report of a case and review of the literature

Peripheral odontogenic lesions are considered to be rare within the classification of odontogenic tumors. Also referred to as extraosseous or soft tissue odontogenic tumors, peripheral odontogenic tumors share the same histopathologic characteristics of their central or intraosseous counterparts. Ameloblastic fibroma is a rare odontogenic tumor that arises from both odontogenic epithelium and connective tissue. Only 2 cases of peripheral ameloblastic fibroma have been reported in the English-language literature, one of which did not show the classic features of an ameloblastic fibroma. In this report, we describe a rare case of a peripheral ameloblastic fibroma in the maxilla of a 3-year-old girl.

Peripheral odontogenic tumor: a clinicopathologic study of 30 cases. General features and hamartomatous lesions

BACKGROUND

Peripheral odontogenic tumors (POT), either neoplastic or hamartomatous, are rare. This study briefly summarizes the general features of POT and selectively reviews the histomorphologic spectrum of under-recognized hamartomatous lesions that we have designated peripheral odontogenic hamartomas (POH) in order to shed more light into the pathogenesis of POT.

METHODS

Archival material accessioned at our institutions between 1970 and 2004 was systematically searched to identify examples of POT/POH.

RESULTS

Among 39 660 biopsies, we retrieved 25 cases of 'classical' POT and five cases of 'unique' POH. Odontogenic fibroma and ameloblastoma were by far the most common. Of POH, two purely epithelial lesions showed multiple strands of basaloid rests [odontogenic gingival epithelial hamartoma (OGEH)] and a conglomerate of polyhedral epithelium, ghost cells and concentric calcifications (calcifying epithelial odontogenic tumor-like hamartoma), respectively. OGEH and peripheral squamous odontogenic tumor (PSOT) deserve to be a related entity. In two types of mixed POH, ectomesenchymal elements appeared juxtaposed to the squamous lining (gingival cyst-like organoid hamartoma) and ghost cells aggregated in the enamel organ of a microdont (peripheral odontoma). None of POH exhibited continuity with the surface epithelium.

CONCLUSION

On the basis of this relatively limited series of cases, POH, to conceptualize a unified histogenetic source, are speculated to arise from the soft-tissue remnants of dental lamina. Gingival rests of Serres seem to retain the ability to pursue epithelial-ectomesenchymal interactions that are necessary leading to odontoma formation.