Recurrent ameloblastic fibro-odontoma in a 10-year-old boy

Are Ameloblastic Fibroma-related Lesions True Tumors?: Evidence Through CNA and BRAF Mutation Analysis

Ameloblastic fibroma (AF) and related lesions, namely ameloblastic fibrodentinoma (AFD) and ameloblastic fibro-odontoma (AFO), span a spectrum from true neoplasms to hamartomas. The 2017 World Health Organization classification proposes that AFD and AFO are precursors to odontomas, yet their precise nature remains uncertain. This study examined 19 AF cases, 4 AFD, 15 AFO, 19 odontomas (OD, 14 complex, 5 compound), and 2 ameloblastic fibrosarcomas (AFS), focusing on clinical characteristics, recurrence, and molecular profiles. AF primarily affected individuals under 20 years (60.0% of cases), mainly in the mandible (68.4%), with a recurrence rate of 21.1% in the followed cases. AFD and AFO appeared in younger patients (average age 15.7 y) without any recurrence observed. Notable differences in site and size distribution were observed between AF, its related lesions, and odontomas. Copy number alterations (CNAs) were detected in the mesenchymal component in 9 of 19 AF (47.4%), 2 of 4 AFD (50.0%), 6 of 14 AFO (42.9%), and 2 of 2 AFS (100%). In contrast, all odontomas exhibited normal CNAs, highlighting the specificity of CNAs in mesenchymal elements of AF and related lesions. BRAF p.V600E mutation was identified in the mesenchymal component in 13 of 19 AF (68.4%), 2 of 4 AFD (50.0%), 8 of 15 AFO (53.3%), and 2 of 2 AFS (100%), whereas all 19 odontomas were BRAF wild type. No mutations were found in the epithelial component. Our analysis reveals that AF and its related lesions present a spectrum of biological behaviors, from true neoplasms to hamartomas. The presence of BRAF p.V600E mutations and CNAs in their mesenchymal components, as opposed to odontomas, indicates potential neoplastic characteristics. Profiling copy number alterations in AF and related lesions emerge as a valuable tool for enhancing their differential diagnosis and facilitating the anticipation of disease progression. Our findings underscore the efficacy of copy number alteration analysis in determining the nature of lesions within AF and related lesions.

Benign Odontogenic Tumours

Odontogenic tumours of the maxillofacial region presents with a large number of histologic patterns and are derived from the primordial tooth forming tissues. They can occur most commonly in mandible and maxilla. The recent WHO classification helps in developing the appropriate treatment plan and categorizing the tumours. The present chapter deals with various benign odontogenic tumours with their clinical presentation and management in detail, based on clinical scenarios.

Ameloblastic Fibroodontoma: Uncommon Case Presentation in a 6-Year-Old Child with Review of the Literature

Ameloblastic fibroodontoma is a benign mixed odontogenic neoplasm considered in patients with asymptomatic swelling and unerupted teeth that exhibit histologic features between ameloblastic fibroma and complex odontoma. Radiographically, this lesion appears as radiolucency admixed with focal radio opaque masses of irregular shapes and sizes. This lesion is confirmed by the presence of proliferating odontogenic epithelium, ectomesenchyme, and dental hard tissue formation on pathological analysis supplementing clinical and radiographic findings. As this tumour is less commonly seen in routine clinical practice, ameloblastic fibroodontoma with detailed orofacial features and periodic approach to its diagnosis is discussed. This paper reports a case of ameloblastic fibroodontoma of the mandible in a 6-year-old male patient with an uncommon case presentation and review of the literature.

Ameloblastic Fibrodentinoma and Ameloblastic Fibro-Odontoma: An Updated Systematic Review of Cases Reported in the Literature

PURPOSE

To integrate the available data published on ameloblastic fibrodentinoma (AFD) and ameloblastic fibro-odontoma (AFO) into a comprehensive analysis of its clinical and radiologic features.

MATERIALS AND METHODS

An electronic search was undertaken in August 2016. Eligibility criteria included publications reporting cases of AFD or AFO with enough clinical, radiologic, and histologic information to confirm the diagnosis. Demographic data, lesion site and size, treatment approach, and recurrence were analyzed and compared between AFD and AFO.

RESULTS

Fifty-four publications reporting on 64 AFDs (60 central, 4 peripheral) and 137 publications reporting on 215 AFOs (211 central, 3 peripheral, 1 unknown) were included. The difference in recurrence rate (when the information about recurrence was provided) was not statistically relevant. The mean age of patients affected by AFD was not statistically different from that of patients affected by AFO.

CONCLUSIONS

AFD and AFO presented several similarities: higher prevalence in men and in the mandibles, similar mean age of patients, rate of cortical bone perforation and of the lesions' association with displaced or unerupted teeth and tooth root resorption, mean lesion size, and recurrence rate. The lesions differed in the presence of radiopacities and locularity. Taken together, these data do not support the concept of progressive maturation of these tumoral conditions.

Three-Dimensional Printing Model as a Tool to Assist in Surgery for Large Mandibular Tumour: a Case Report

Objectives

Recently, three-dimensional printing models based on preoperative computed tomography and magnetic resonance imaging images have been widely used in medical fields. This study presents an effective use of the three-dimensional printing model in exploring complex spatial relationship between the tumour and surrounding tissue and in simulation surgery based planning of the operative procedure.

Material and Methods

The patient was a 7-year-old boy with ameloblastic fibro-odontoma. Prior to surgery, a hybrid three-dimensional printing model consisting of the jaw bone, the tumour and the inferior alveolar nerve was fabricated. After the simulation surgery based on this model, enucleation of the tumour, leaving tooth 46 intact (Universal Numbering System by ADA) safe, was planned.

Results

Enucleation of the tumour was successfully carried out. One year later, healing was found to be satisfactory both clinically and radiographically.

Conclusions

The study presented an effective application of a novel hybrid three-dimensional printing model composed of hard and soft tissues. Such innovations can bring significant benefits, especially to the field of oncological surgery.

Diverse calcification patterns of ameloblastic fibro-odontoma on radiographic examination

The occurrence of ameloblastic fibro-odontoma (AFO) in the oral region is unusual and accounts for 1-3% of all odontogenic tumors. AFO presents mixed radiopaque patterns within the lesion with diverse findings; therefore, it is important to compare this tumor with other odontogenic tumors that radiographically present with calcified bodies. Herein, we observed the calcification patterns within the lesion in seven AFO cases (five males, two females; mean age, 8.3 years; age range, 4-13 years). Periapical and panoramic radiographs were obtained from all seven cases. Five cases underwent conventional computed tomography (CT) scanning, and one underwent cone beam CT. Classification of the calcifications primarily involved the following two characteristics on the X-rays: appearance and location of the lesions. All seven cases were located in the molar regions of the mandible in association with impacted teeth. The calcification patterns of these AFOs were mixed or inhomogeneous within the lesion with various findings, including complex odontoma-like calcifications. However, the patterns differed between panoramic radiography and CT in some cases. The radiolucent lesions in AFO demonstrated varying calcification patterns and were associated with impacted teeth on the CT images.(J Oral Sci 58, 533-537, 2016).

Large ameloblastic fibro-odontoma in a 7-year-old girl with analysis of 108 cases

BACKGROUND

Odontogenic tumors such as ameloblastic fibro-odontoma (AFO) are rare conditions in children and are often asymptomatic. AFOs are found by routine clinical and radiological examination or when they cause obvious intra- or extra-oral swelling.

MATERIALS AND METHODS

A case of an AFO in a 7-year-old girl is described, and 107 cases from the literature and this report are analyzed.

RESULTS

The total of 108 cases revealed the average age at presentation of AFO to be 6.3 years in boys and 9.6 years in girls. There was a slight male predilection and AFO lesions most often occurred in the posterior mandible. AFO was almost always associated with an unerupted tooth or teeth.

CONCLUSIONS

While the recurrence rate of AFO was found to be 5.5%, long-term postoperative clinical and radiological follow-up is advised to ensure no future signs of aggressive recurrence.

Aggressive ameloblastic fibro-odontoma assessment with CBCT and treatment

BACKGROUND

Ameloblastic fibro-odontomas (AFO) are rare lesions and defined by the World Health Organisation as a tumour composed of a proliferation of odontogenic epithelium immersed in ectomesenchyme reminiscent of the interdental papilla. It also presents inductive processes leading to formation of enamel and dentine, confusing, histopathologically, with odontoma. Despite numerous efforts, there is still considerable confusion over its controversial aetiopathogenesis and treatment. A brief review of the literature on the clinical, pathological and therapeutic features of this lesion is reported.

CASE REPORT

A case of aggressive AFO in a 3-year-old boy was referred to the Oral Diagnostics Service of Hospital General de Fortaleza for evaluation following a 3-months painless swelling in the right mandibular and facial regions. During anamnesis, the patient's carers reported no systemic problem and his medical history was non-contributory. Intra-orally there was a swelling of the right lateral portion of the mandible, adjacent teeth were not mobile and the oral mucosa appeared normal and showed no signs of ulceration. Radiographic examination, with panoramic radiography and cone beam computed tomography with three-dimensional (3D) reconstruction, was better able to identify the extent of bone involvement and showed an expansive hypodense image in the right mandibular region. 3D reconstruction showed expansion of buccal and lingual cortical bone and the preservation of basal bone.

TREATMENT

Enucleation and curettage of the lesion were carried out and care was taken not to fracture the basal bone during the surgical procedure. Tissue specimens were sent for histopathologic analysis. Aspiration performed during surgery was negative for blood and other exudates.

FOLLOW-UP

No recurrence has occurred during a follow-up period of 11 months.

CONCLUSION

A comprehensive diagnosis including all clinical, radiographic and histopathologic features is necessary for the success of therapy, which varies from case to case, thus, improving the quality of life of patients with AFO.

Large ameloblastic fibro-odontoma in an 18-year-old girl and review of literature

The ameloblastic fibro-odontoma is a rare, benign, mixed neoplasm composed of proliferating odontogenic epithelium, ectomesenchymal tissue and varying degrees of dental hard tissue formation. It occurs exclusively as an intraosseous lesion. It usually exhibits slow growth and is commonly seen in children and young adults. Radiologically, ameloblastic fibro-odontoma appears as a circumscribed radiolucency which may contain radiopaque foci. Most cases of ameloblastic fibro-odontoma exhibit benign behaviour, but cases of malignant transformation have been reported. The treatment modality in most cases involves conservative surgery, but in cases with malignant transformation more radical treatment will be required. A massive ameloblastic fibro-odontoma involving the mandible is being described here with its clinical, radiological and histopathological features.

Clinical and radiological profile of ameloblastic fibro-odontoma: an update on an uncommon odontogenic tumor based on a critical analysis of 114 cases

Ameloblastic fibro-odontoma is an uncommon benign tumor of the jaws that belongs to the group of mixed odontogenic tumors. The descriptions of its clinical and radiological features in the literature are not always accurate and sometimes even contradictory. The aim of the present study was to critically evaluate their clinical and radiological features as reported in the English-language literature. A total of 114 well-documented cases of ameloblastic fibro-odontomas (103 from publications and 11 of our own new cases) were analyzed. The patients' age ranged from 8 months to 26 years (mean 9.6). There were 74 (65 %) males, with a male-to-female ratio of 1.85:1 (P = 0.001). The mandible was involved in 74 (65 %) cases, and the mandible-to-maxilla ratio was 1.85:1 (P < 0.001). Nearly 80 % of the lesions were located in the posterior region of the jaws, and most (58 %) were in the posterior mandible. Radiographically, most of the lesions were unilocular and only a few (~10 %) were multilocular. Most lesions were mixed radiolucent-radiopaque, and only a few (~5 %) were radiolucent. Almost all lesions (~92 %) were associated with the crown of an unerupted tooth/teeth. This comprehensive analysis of a large number of patients with an uncommon lesion revealed that ameloblastic fibro-odontomas are significantly more common in males and in the mandible, and that multilocular lesions are uncommon. It also revealed that, based on their clinical and radiological features, some of them are probably true neoplasms while others appear to be developing odontomas (hamartomas).

Ameloblastic fibro-odontoma: expansile mixed radiolucent lesion in the posterior maxilla: a case report

Ameloblastic fibro-odontoma (AFO) is a benign tumor that displays properties of both ameloblastic fibroma and compound odontoma. Often, AFO presents clinically as a hamartoma or immature odontoma; however, the tumor can also present with progressive growth causing bone destruction and significant deformity, acting more like a true neoplasm. We report a case of a locally aggressive AFO in the posterior maxilla of a 7-year-old girl and discuss the clinical, radiographic, histopathologic, and conservative therapeutic approach to this locally aggressive tumor.

An unusual size of ameloblastic fibro-odontoma

Ameloblastic fibro-odontoma (AFO) is a quite rare, mixed odontogenic tumour generally seen in the early stages of life. Frequent signs of the tumour are asymptomatic swelling, delayed tooth eruption and mixed radiological appearance within well-defined borders. Management of the lesion includes enucleation of the tumour and long-term follow-up in order to avoid recurrence. A 9-year-old girl was referred to our clinic with swelling in her right cheek. After clinical and radiographic examination, a large lobular radiopaque mass with a radiolucent border covering the complete right maxillary sinus was observed. Under general anaesthesia, the lobules of the lesion were enucleated and the permanent right lateral incisor and canine teeth were left for eruption. Histological assessment revealed a final diagnosis of ameloblastic fibro-odontoma. Post-operative healing was uneventful and the remaining teeth erupted normally. No recurrence was observed during the 3 years' follow-up period.

Management of ameloblastic fibro-odontoma in a 6-year-old girl preserving the associated impacted permanent tooth

The ameloblastic fibro-odontoma (AFO) is a rare odontogenic tumor that occurs predominantly in children and is generally associated with unerupted teeth. The choice of treatment for this entity is conservative surgery with enucleation and its prognosis is excellent. However, preserving the associated impacted teeth may make complete removal of the lesion difficult and may explain some cases of recurrence. A case of AFO in a 6-year-old girl treated with enucleation and preservation of an impacted lower left first permanent molar is reported. After two years of follow-up, there were no signs of recurrence and complete spontaneous eruption of the preserved tooth was observed. The present report indicates that the degree of involvement of the impacted tooth by AFO is a fundamental aspect to be considered during radiological analysis and surgical assessment. We concluded that preservation of the impacted permanent teeth associated with this tumor should always be considered and carried out with caution, since they are clearly not included in the surgical cavity.

Ameloblastic fibroma and related lesions: a clinicopathologic study with reference to their nature and interrelationship

BACKGROUND

Ameloblastic fibroma (AF) and related lesions constitute a group of lesions, which range in biologic behavior from true neoplasms to hamartomas. The aim of this study was to elucidate the nature and interrelationship of this group of lesions.

METHODS

Clinical and pathological studies were undertaken retrospectively on 13 cases of AF and seven cases of ameloblastic fibro-odontoma (AFO). Thirty-three complex odontomas and 33 compound odontomas were also included for comparative purpose. Relevant follow-up data were recorded and the literature was reviewed.

RESULTS

The majority of patients with AF (nine cases, 69.2%) were over the age of 22 years with frequent involvement (76.9%) of the posterior mandible. Tumors recurred in four of 11 patients with follow-up information and two recurrent tumors showed malignant transformation. There was no case in this series that could be designated as the so-called ameloblastic fibrodentinoma, apart from one recurrent AF in which further maturation to form only tubular dentin materials was identified. AFO tended to occur at a younger age group with an average of 9.6 years. Recurrence was noted in two of five patients with follow-up data and both recurrent lesions showed limited growth potential and further maturation into a complex odontoma. Significant differences were noted in the age and site distribution between the complex and the compound odontomas.

CONCLUSION

Whilst the majority, if not all, of AFs are true neoplasms with a potential to recur and/or of malignant transformation, some, especially those occurred during childhood, could represent the primitive stage of a developing odontoma. Our data also suggests that some AFOs are hamartomatous in nature, representing a stage preceding the complex odontoma.

Fibro-odontome ameloblastique mandibulaire

Ameloblastic fibro-odontoma is a rare and benign tumor. It usually affects young patients. This report describes the case of a ten year old child presenting an asymptomatic and slow-growing tumor located in the posterior region of the mandible. The course was normal and no recurrence was found after simple enucleation of the tumor.