Cystic variant of calcifying epithelial odontogenic tumor

Noncalcifying type of calcifying epithelial odontogenic tumor: A rare case report and literature review

Key Clinical Message

There has been a recent spike in reporting of noncalcifying variants of CEOT with the WHO 2022 classification of head and neck tumors. The present case describes a rare histopathological variant of CEOT of which a handful of cases have been reported.

Abstract

This work aimed to report a rare case of noncalcifying type of Pindborg Tumor involving the right mandible. The absence of calcifications in the calcifying epithelial odontogenic tumor presents a diagnostic challenge and prognostic implications. A literature review of the 16 reported clinical cases of this scarce variant was performed.

Calcifying epithelial odontogenic tumor: a case series spanning 25 years and review of the literature

OBJECTIVE

The calcifying epithelial odontogenic tumor (CEOT) is a rare benign neoplasm that makes up less than 1% of all odontogenic tumors. This study aims to describe a case series of CEOT spanning 25 years and to review and compare our results with the existing literature.

STUDY DESIGN

With institutional review board approval, all CEOT archival cases from the University of Florida Oral Pathology Biopsy Service between 1994 and 2019 were retrieved. A total of 20 cases were included. Based on current criteria, 2 cases that stained positively for CD1 a were excluded, because these most likely represented the amyloid-rich variant of central odontogenic fibroma.

RESULTS

Average patient age was 40 years. Females and males were affected equally (n = 10). The mandible was more commonly involved (60%, n = 12) than the maxilla (40%, n = 8). CEOT variants included incipient CEOT (10%, n = 2) and peripheral CEOT (10%, n = 2). One case exhibited features of adenomatoid odontogenic tumor in addition to CEOT. Congo red staining for amyloid was performed in 13 cases, all of which were positive.

CONCLUSION

Our results align with the literature. Awareness of the different variants of CEOT and of the separate but similar-appearing amyloid-rich variant of central odontogenic fibroma will help to ensure accurate diagnosis and appropriate treatment.

CEOT Variants or Entities: Time for a Rethink? A Case Series with Review of the Literature

The first detailed description of calcifying epithelial odontogenic tumor (CEOT) are ascribed to Jens Pindborg, but this tumor was described some years previously. Subsequently, CEOT was included in the 1971 WHO classification of odontogenic tumors and a since then number of variants have been described, which have added confusion to the diagnostic criteria. We aimed to survey the literature on the variants of CEOT, in parallel with a review of our single institution experience of CEOTs. Cases identified were collated, including available clinical, radiological and histological information and then reviewed, taking into account changes in the understanding and classifications of odontogenic tumors since initial diagnosis. We identified 26 cases from 1975 to 2017 for which histological material was available. Of these, only 13 (50%) showed the "classic" histological appearance, whilst two cases were identified as recognized variants. In 11 cases, other diagnoses or a differential diagnosis were preferred, with no agreed diagnosis in four of these. The proliferation fraction (Ki67) in the 10 cases tested was 2.1% ± 0.18. These findings illustrate the diagnostic challenges in this group of tumors and highlight the gaps in knowledge. Techniques, such as EWSR1 gene cytogenetic analysis, may be helpful in cases with clear cells. However, in other areas of controversy, including the non-calcifying and Langerhans cell rich variants, further investigation, perhaps utilizing sequencing technologies may be needed to refine the classification. Owing to the relative rarity of these lesions it would be beneficial if future work could be pursued as an international collaboration.

Calcifying Epithelial Odontogenic (Pindborg) Tumor in a Child: A Case Report and Literature Review

Calcifying epithelial odontogenic tumor (CEOT) is a rare neoplasm, which accounts for < 1% of all odontogenic tumors. CEOT occurs more frequently in adults with a peak incidence in the 5th decade of life and is extremely rare in the pediatric population. We present a case of a 13-year-old girl who was found to have a mandibular CEOT. We summarize the radiological features, pathological findings, clinical management and literature review focusing on this entity in children.

Treatment of a calcifying epithelial odontogenic tumour with tube decompression: a case report

Conservative treatment of odontogenic tumours with decompression or marsupialisation is not common, but can be done successfully in those with a cystic pattern. We present a calcifying epithelial odontogenic tumour that was treated by tube decompression and subsequent enucleation.

Dentigerous cyst with parietal and intracystic calcifications: A case report and literature review

Background

Dentigerous cyst appears surrounding the crown of an included tooth. On the radiographic exam, a radiolucent rounded well-defined lesion can be observed.

Material and Methods

This study reports a clinical case of a 34-years old man with a pericoronal radiolucent lesion associated to an impacted lower third molar with the presence of radiopaque material inside. The radiological differential diagnosis was calcifying odontogenic tumor, adenomatoid odontogenic tumor and dentigerous cyst. The impacted third molar was removed and the lesion was sent for the histopathological exam.

Results

The histopathological diagnosis was dentigerous cyst with capsular calcifications. Specifically, parietal calcifications on its connective wall and a piece of cemento-osseous tissue inside.

Conclusions

Non-neoplastic lesions such as dentigerous cysts could develop radiopacities inside the radiolucent pericoronal area. Key words:Dentigerous cyst, calcifications, third molar, differential diagnosis.

Microcystic Calcifying Epithelial Odontogenic Tumor

Microcystic variant of calcifying epithelial odontogenic tumor is rare. We herein describe an additional well-documented case of microcystic CEOT. The affected patient is a Guatemalan 42-year-old female with an expansile well-defined mixed radiolucent-radiopaque lesion located in the right posterior mandible. The lesion was associated to an unerupted third molar. Histopathologic examination revealed nests and cords of moderately pleomorphic, eosinophilic polyhedral epithelial cells surrounded by a fibromyxoid stroma. The neoplastic cells showed microcystic pattern made of pseudo-glandular spaces with variable diameter. Occasional amyloid deposits and calcified acellular material were observed. Tumor cells were positive for AE1/AE3, CK14, CK19, p63, CD138, and beta-catenin. Conservative surgical resection was performed with an uneventful immediate post-surgical follow-up. After 1 year follow-up there is no evidence of recurrence. Pathologists should be aware of this unusual microcystic presentation of CEOT, which may pose a diagnostic challenge and potential diagnostic dilemma.

Maxillary calcifying epithelial odontogenic tumor with sinus and buccal vestibule extension: a case report and immunohistochemical study

Background

Calcifying epithelial odontogenic tumor (CEOT) is a rare benign neoplasia, locally aggressive, that tends to invade bone and adjacent soft tissues. This case report describes the thirteenth known case of CEOT with maxillary sinus extension and the second one that also involves the buccal vestibule mucosa with peculiar histopathological and immunohistochemical data.

Case presentation

Here we report the case of a 45-year-old female with a CEOT diagnosed and treated at the Oral & Maxillofacial Surgery Department, County Clinical Emergency Hospital of Craiova, Romania. The clinical and imaging investigation revealed an intraosseous tumor developed from the left posterior maxilla with maxillary sinus and buccal vestibule mucosa extension. Histopathology found an epithelium-rich CEOT variant, but with scattered S100 positive clear cells, focal small rounded cementum-like deposits and areas with some degree of nuclear pleomorphism. The immunohistochemical investigations emphasised its local aggressiveness behavior with involvement of multiple molecular mechanisms that underlie tumor invasiveness. A subtotal maxillectomy was performed followed by defect reconstruction.

Conclusions

We discuss the relevant clinicopathological features of an aggressive rare case of CEOT with maxillary sinus extension and buccal vestibule mucosa involvement. The immunohistochemical study suggests its utility in attempting to assess the degree of local tumor aggressiveness and thus in adopting the most efficient therapeutic attitude.

Clear cell variant of calcifying epithelial odontogenic tumor: Case report with immunohistochemical findings

Calcifying epithelial odontogenic tumor (CEOT) is a rare benign odontogenic neoplasm, locally aggressive, characterized by sheets and nests of polyhedral epithelial cells exhibiting eosinophilic cytoplasm or less often clear cytoplasm. Additional features include nuclear pleomorphism without mitotic activity, concentric calcifications, and deposits of amyloid. Herein, we present an additional example of clear cell variant of CEOT occurring in a 25-year-old female. Microscopically, the tumor consisted on proliferation of epithelial cells with eosinophilic, clear vacuolated cytoplasm interspersed with focal areas of amyloid deposition. Tumor cells were immunopositive for AE1/AE3, CK14, CK19, β-catenin, CD138, and p63.

Key words:Calcifying epithelial odontogenic tumor, clear cell, histopathology, immunohistochemistry.

Clear cell cystic variant of calcifying epithelial odontogenic tumor

Calcifying epithelial odontogenic tumor (CEOT) is a solid, locally aggressive, benign odontogenic neoplasm characterized by sheets and nests of polyhedral epithelial cells exhibiting eosinophilic and less often clear cytoplasm, occasional nuclear pleomorphism without mitotic activity, calcifications, and deposits of amyloid. A cystic variant has been reported only twice. Herein, we present an additional example of cystic CEOT occurring in a 31-year-old male and featuring clear cell epithelial lining with deposits of amyloid and osteodentin.

Peripheral calcifying epithelial odontogenic tumor - Case report

The calcifying epithelial odontogenic tumor (CEOT), Pindborg tumor is a benign, slow growing, but locally invasive neoplasm. It is known to have a common intraosseous variant and a very rare extraosseous variant. We report an unusual case of an extraosseous variant of CEOT of unusual large size and maxillary anterior location, the treatment was planned considering the clinical, radiological and histological features. Though peripheral types are less aggressive and had no recurrence, in our case regular follow up is required considering the aggressiveness of the lesion and its proximity to important adjacent structures.

A clinicopathologic study on calcifying epithelial odontogenic tumor: with special reference to Langerhans cell variant

BACKGROUND

Calcifying epithelial odontogenic tumour (CEOT) is a rare benign odontogenic tumour, and its Langerhans cell variant is even rarer. Due to the limited number of recorded cases, the biological behaviour and histogenesis of the Langerhans cell variant of CEOT are not yet fully understood. Thus, the correlation between conventional CEOT and the Langerhans cell variant remains to be clarified.

MATERIAL (CASES)

Eight cases of CEOT including 2 cases of Langerhans cell variant were clinicopathologically studied and the English language literature was reviewed. Langerhans cells were detected in 2 cases of conventional CEOT and in 2 cases of Langerhans cell variant by immunohistochemistry.

RESULTS AND FINDINGS

In the 6 cases of conventional CEOT, 5 tumours involved the premolar and molar region and the anterior portion of the mandible was affected in 1 case. Four patients were followed for 2-7 years and did not show any sign of recurrence. A review of the English language literature revealed 5 cases; combined with the present 2 new cases, a total of 7 cases of Langerhans cell variant of CEOT were collected. The patients were all Asian. Six tumours occurred in the maxilla and 1 in mandible; all mainly involved the anterior region of the jaws. Five patients were followed for 2-10 years and did not show any evidence of recurrence. Langerhans cells can be seen in both the conventional and the Langerhans cell variant of CEOT; however, increased numbers of Langerhans cells are seen in the latter.

CONCLUSIONS

Although the Langerhans cell variant of CEOT is a rare entity and behaves similarly to the conventional type, it could show unique clinical and histologic features that may pose problems for differential diagnosis.

VIRTUAL SLIDES

http://www.diagnosticpathology.diagnomx.eu/vs/1979090740113894.

Distintas manifestações do tumor odontogênico cístico calcificante

O tumor odontogênico cístico calcificante normalmente se manifesta como uma massa indolor, de crescimento lento, que acomete tanto a maxila como a mandíbula, tendo predileção pelo segmento anterior (área dos incisivos e caninos). Geralmente, ocorre em adultos jovens, na terceira a quarta década de vida, sem preferência por gênero. Imagens de tomografia computadorizada revelaram características importantes não detectadas na radiografia panorâmica, tais como fenestração, calcificação e estruturas dentiformes. A característica microscópica típica dessa lesão é a presença de células epiteliais aberrantes anucleadas, em quantidades variáveis, denominadas "células fantasmas". Também se pode encontrar dentina displásica e, ocasionalmente, os cistos estão associados a tecido dentário duro, semelhante ao odontoma. O tratamento do tumor odontogênico cístico calcificante incluiu simples enucleação e curetagem. O objetivo deste trabalho foi mostrar duas manifestações diferentes do tumor odontogênico cístico calcificante, em que a tomografia computadorizada, associada às características clínicas, foi ferramenta importante para o diagnóstico, o planejamento cirúrgico e o acompanhamento dos pacientes.

Cystic variant of calcifying epithelial odontogenic tumor

The calcifying epithelial odontogenic tumor is a rare benign odontogenic neoplasm of the jaw. Clinically, calcifying epithelial odontogenic tumor manifests as an intraosseous lesion (central type) in the majority of cases (95%). Extraosseous or peripheral lesions account for less than 5% of cases. Calcifying epithelial odontogenic tumor can be associated with an impacted tooth and give a radiographic simulation of dentigerous cyst. Most calcifying epithelial odontogenic tumors are solid in nature, histopathologically, and might have few cyst-like spaces within them. However, a true cystic calcifying epithelial odontogenic tumor is a rare possibility. We describe a case of a true cystic variant of calcifying epithelial odontogenic tumor in a 30-year-old male, which to our knowledge, is only the second reported case.