Clear-cell variant of calcifying epithelial odontogenic tumor: clinical and radiographic characteristics

Giant calcifying epithelial odontogenic tumor after I-125 seed implantation: A case report

Calcifying Epithelial Odontogenic Tumor (CEOT), also known as Pindborg tumor, is a rare odontogenic benign tumor. It was first reported by Thoma and Goldman in 1946 and defined as an independent tumor by Pindborg in 1957. Herein, we reported a CEOT case involving most of the mandible after I-125 implantation in a 53-year-old man. We cooperated with governmental and hospital departments to resect the tumors, reconstruct the mandible with a fibular flap graft, and properly dispose of the radioactive particles.

Noncalcifying clear-cell variant of calcifying epithelial odontogenic tumor: A case report and review

Clear-cell tumors of the head and neck are biologically diverse consisting of benign, malignant and metastatic lesions. These tumors pose a diagnostic challenge. In the oral cavity, these may be derived from odontogenic/nonodontogenic epithelium or from mesenchyme or can be metastatic. Odontogenic tumors with clear-cell change are rare. Calcifying epithelial odontogenic tumor (CEOT) is a rare, benign, locally aggressive odontogenic epithelial tumor affecting the jaw. Here, we report a case of clear-cell variant of CEOT with its histopathological differential diagnosis. A 43-year-old male patient with swelling in his lower right back tooth region showed a well-defined radiolucent lesion with smooth corticated periphery on radiograph. On incisional biopsy, tumor showed small sheets, cords and islands of odontogenic epithelium with nests of clear cells with no evidence of calcification. A final diagnosis of CEOT was established by differentiating other odontogenic and nonodontogenic lesions on the basis of clinical, radiographic, histopathologic and special stain features.

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.

Odontogenic tumors: A review of 93 cases in the Vidharba region of Maharashtra

Background:

Tumors of the odontogenic origin (OTs) are rare tumors accounting for 1% of all the jaw tumors in the oral cavity. The behavior of these tumors ranges from hamartomatous proliferation to malignant neoplasm.

Aim:

The aim of this study was to determine the epidemiological data, clinical and histopathological picture with variants of the OTs diagnosed at our institute in the Vidarbha region.

Settings and Design:

A retrospective study was carried out with the permission from the institutional authorities. The archival records of the Department of Oral Pathology and Microbiology were reviewed.

Materials and Methods:

A total of 93 cases of OTs were reviewed retrospectively from the archival records of the Department of Oral Pathology and Microbiology from January 2008 to December 2018. Statistical analysis was carried out and the determination of the age, gender, jaw, site, diagnosis, variants and year-wise distribution of odontogenic lesions was taken out using the SPSS software.

Results:

Ninety-three cases of OTs were identified. The most common OT identified was ameloblastoma (n = 37/39.7%) followed by keratocystic OT (n = 8/8.6%), adenomatoid OT (n = 7/7.5%) and odontome (O) (n = 6/6.4%). The tumors were diagnosed in a wide age range from 1^st to 3^rd decennium of life. The mandibular posterior region was the most commonly affected anatomical site with the maxilla and mandible ratio of 1:6.

Conclusion:

OTs were found to be rare in the sample studied. The findings of the study were in concordance to those of Asian and African series. Variations were shown from the series of American reports, and further investigations are needed for this disparity.

A Rare Case of an Aggressive Clear Cell Variant of Calcifying Epithelial Odontogenic Tumor in the Posterior Maxilla

A clear cell variant of calcifying epithelial odontogenic tumor is a rare benign odontogenic neoplasm, accounting for 33 cases described in the literature. In this article, we report a challenging example of clear cell variant of calcifying epithelial odontogenic tumor of the posterior maxilla in a 45-year-old female patient showing locally aggressive growth and recurrence. Microscopically, islands of polyhedral cells containing abundant cytoplasm, well-developed intercellular bridges blended with clear cells were observed. The nuclei were frequently pleomorphic and permeated by hyaline calcified material. Immunohistochemistry revealed positivity for pan-cytokeratin (AE1/AE3), cytokeratins (CK-14 and CK-19), Bcl-2, p53, and p63. The Ki-67 proliferative index was ~10%. As odontogenic tumors are rare, when a significant clear cell component is observed, the differential diagnosis with other lesions of the jaws with similar morphology, including other odontogenic tumors with prominent clear cell component, clear cell odontogenic carcinomas, and metastatic tumors, is difficult.

Odontogenic Carcinoma With Dentinoid in Long-Term Follow-up With 2 Recurrences

Dentinoid has been mentioned as a frequent component in several types of benign odontogenic tumors; however, there are some other very rare dentinoid-producing odontogenic tumors that have been described, which are not recognized in the current World Health Organization Histological Classification of Odontogenic Tumours. In this context, we report an unusual malignant odontogenic tumor containing dentinoid located in the left maxilla of a 41-year-old man. The lesion was initially diagnosed and treated as a cemento-ossifying fibroma. After 7 years, a tumor was noted at the same location and was diagnosed as pleomorphic adenoma. The patient developed a new lesion 2 years later. Histological features included an epithelial proliferation of basaloid and clear cells, some with peripheral palisading, which were scattered both in a fibrous stroma and within an amorphous eosinophilic dentinoid product. Because of doubts about the first 2 diagnoses and the current situation, all histopathological slides were reviewed in our service as a consultation case, and the findings were consistent with the diagnosis of an odontogenic carcinoma with dentinoid. Immunohistochemical analysis was performed and an ultrastructural study by scanning electronic microscopy and energy-dispersive X-ray microanalysis was made to characterize dentinoid material. After 1 year of follow-up, the patient is alive and free of the disease. This case highlights the wide variability regarding cytological evidence of malignancy, and adds a new case of odontogenic carcinoma with dentinoid, which represents a distinct entity with locally aggressive behavior and should be considered be included in a future World Health Organization Histological Classification of Tumours.

Update on Odontogenic Tumors: Proceedings of the North American Head and Neck Pathology Society

Odontogenic tumors are rare entities, often derived from the epithelial remnants in the gnathic bones following odontogenesis. This brief manuscript will seek to address recent developments pertaining to odontogenic tumors as well as particularly uncommon odontogenic tumors and the difficulties in their diagnosis.

Is Conservative Surgery the Best Approach for Peripheral Calcifying Epithelial Odontogenic Tumors?

Background:

Peripheral Calcifying Epithelial Odontogenic Tumors (CEOT) rich in clear cells are a rare entity in the oral cavity, with only 14 previous case reports in the English literature. None have discussed recommended treatment approaches for extraosseous CEOT.

Objective:

This brief descriptive review describes a treatment approach for peripheral CEOT including the clear cell variant.

Study design:

A complete review of all well-documented extraosseous case reports with an emphasis on the treatment was performed. Additionally, the present article reports a case of a 21-year-old woman with an asymptomatic swelling in the gingiva finally diagnosed as peripheral CEOT abundant in clear cells.

Results:

Twenty-four cases of peripheral CEOT were described; conservative surgery was the first treatment approach in approximately 80% of cases, with only one recurrence.

Discussion:

Clear cell finding was not associated with more aggressive behavior.

Conclusion:

Conservative surgery may be an advantageous approach for this group of peripheral lesions with or without clear cells, with a recurrence rate of approximately 4%.

Peripheral Clear Cell Variant of Calcifying Epithelial Odontogenic Tumor: Case Report and Review of the Literature

Calcifying epithelial odontogenic tumor (CEOT) is classified as an uncommon, benign, odontogenic neoplasm that is exclusively epithelial in origin. Of all reported cases, peripheral tumors account for 5-6 %, among which clear cell variants are still rare. A rare case of peripheral clear cell variant of CEOT occurring in the mandibular gingiva of a 47-year-old female is presented.

Odontogenic Cysts and Tumors

This article presents various odontogenic cysts and tumors, including periapical cysts, dentigerous cysts, odontogenic keratocysts, orthokeratinized odontogenic cysts, lateral periodontal cysts, glandular odontogenic cysts, ameloblastomas, clear cell odontogenic carcinomas, adenomatoid odontogenic tumors, calcifying epithelial odontogenic tumors, squamous odontogenic tumors, ameloblastic fibromas, ameloblastic fibro-odontomas, odontomas, calcifying cystic odontogenic tumors, and odontogenic myxomas. The authors provide an overview of these cysts and tumors, with microsopic features, gross features, differential diagnosis, prognosis, and potential diagnostic pitfalls.

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.

DNA methyltransferase immunohistochemical expression in odontogenic tumours

BACKGROUND

Odontogenic tumours are a heterogeneous group of lesions formed from tissues that give rise to the tooth. DNA methylation, a covalent addition of a methyl group to the 5-carbon position of a cytosine nucleotide, is considered an important regulator of gene expression. The addition of the methyl radical is catalysed by DNA methyltransferases (DNMTs). Although some epigenetic studies have been conducted in odontogenic tumours, a study with the three types of DNMTs in several different members of this group is missing. This study analyses the expression of DNMTs in odontogenic tumours.

METHODS

Formalin-fixed and paraffin-embedded tissue samples of 20 ameloblastomas, 10 calcifying cystic odontogenic tumours, 10 calcifying epithelial tumours, 10 adenomatoid odontogenic tumours, 10 keratocystic odontogenic tumours, five ameloblastic fibromas, two ameloblastic fibro-odontomas, four central odontogenic fibromas, seven peripheral odontogenic fibromas and 10 odontogenic myxomas were included. Immunohistochemical expression of DNMT1, 3A and 3B was assessed using a semi-quantitative analysis, and also a correlation with p21, p27 and E-cadherin immunoexpression was made.

RESULTS

DNMT1, 3A and 3B were expressed in the nucleus and/or cytoplasm of all odontogenic tumours. DNMT1 expression was directly correlated with p27 expression in ameloblastomas.

CONCLUSION

The high expression of DNMTs in odontogenic tumour cells suggests methylation as an important mechanism for this group of tumours.

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.

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.

Clear cell variant of calcifying epithelial odontogenic tumor without calcification: a rarity

Calcifying epithelial odontogenic tumor (CEOT) is a rare, benign, locally aggressive odontogenic epithelial tumor that affects the jaws. Although there are numerous reports on the variants of CEOT, occurrence of clear cells with complete absence of calcification has been a rarity. Histochemical analysis of tumor cells revealed glycogen granules with PAS staining, with absence of CD 1a staining in clear cells, while the amyloid-like deposit associated with clear cells showed green birefringence with Congo red. We report an unusual variant of CEOT occurring in a 27 years old male patient.

Calcifying epithelial odontogenic tumour with clear langerhans cells: a novel variant, report of a case and review of the literature

Clear cell calcifying epithelial odontogenic tumour (CCEOT) is a rare variant of calcifying epithelial odontogenic tumor (CEOT). While it is not surprising to find clear cells in odontogenic lesions, the exact nature of the clear cells in CCEOT has not been elucidated. Herein, we report a case of peripheral CCEOT of anterior mandible in a 37 year old black female. Histologically, the tumour consisted of cords and small nests of clear cells surrounded by dense deposits of amyloid and basophilic calcifications. The cells possessed abundant clear cytoplasm and eccentrically located indented nuclei. Admixed with the clear cells were eosinophilic cuboidal to polyhedral cells. The clear cells were PAS negative and immunoreactive for S100 protein, CD1a and Langerin. The clear cells were negative for MNF-116, SMA, Desmin and CK-19. It is therefore recommended to recognize two variants of CCEOT, namely, CEOT with clear cell change and CEOT with clear Langerhans cells (LC). We further suggest that the contradictory term "non-calcifying variant of calcifying epithelial odontogenic tumour with LC" to be abandoned, as the current case clearly indicates that LC could be seen in CEOT irrespective of the presence or absence of calcifications.

Clear-cell variant of calcifying epithelial odontogenic tumor (Pindborg tumor) in the mandible

We present an uncommon case (female patient aged 59 years) of the clear-cell variant of calcifying epithelial odontogenic tumor (CEOT) (also known as Pindborg tumor) in the mandible. The clinical characteristics and probable origins of the clear tumor cells of previously reported cases of clear-cell variant of intraosseous CEOT are also summarized and discussed.

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.

Clear cell calcifying epithelial odontogenic (Pindborg) tumor involving the maxillary sinus: A case report and review of literature

Calcifying epithelial odontogenic tumor (CEOT) is a rare benign odontogenic neoplasm of the jaws, accounting for less than 3% of all odontogenic tumors. It rarely extends into the maxillary sinus. Till date, six cases involving maxillary sinus have been reported. In this paper, we report the seventh case of a 52-year-old male with CEOT in maxilla extending from distal surface of the right maxillary canine to retromolar area and involving maxillary sinus with no association with impacted teeth. The diagnosis was confirmed by aspiration cytology and histologically, the tumor was composed of sheets of epithelial cells, with areas of clear cell changes. The presence of clear cells in the histological sections, accounts for the aggressive nature of the tumor simulating the clinical appearance. Prevention of recurrence can be achieved by radical resection.

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.

Recurrent bilateral gingival peripheral calcifying epithelial odontogenic tumor (Pindborg tumor): a case report

Calcifying epithelial odontogenic tumor (CEOT) is an extremely rare, benign neoplasm, accounting for approximately 1% of all odontogenic tumors. Peripheral CEOTs commonly resemble oral hyperplastic or reactive lesions and are histologically similar to their intraosseous counterparts. We report an unusual case of multifocal peripheral CEOT. A 40-year-old female presented with bilateral soft, painful, erythematous, gingival swellings localized in premolar areas of the mandibular gingiva. The presumptive diagnosis was bilateral pyogenic granuloma. The masses were surgically excised under local anesthesia without bone curettage and both recurred 12 months later. Morphologic features, and histochemical and immunohistochemical tests revealed bilateral peripheral calcifying odontogenic epithelial tumor. There is no clinical or radiographic evidence of recurrence 3.5 years after excision. This multifocal phenomenon has been reported previously only for intraosseous CEOT. Gingival masses must be carefully evaluated for clinical and histologic evidence of neoplasia.

Hyalinizing clear cell carcinoma: case series and comprehensive review of the literature

BACKGROUND

Hyalinizing clear cell carcinoma (HCCC) is an uncommon malignant salivary gland tumor that was characterized only recently as a distinct entity. Because of its histologic similarity to several other primary and metastatic tumors and its purported favorable clinical outcome after local resection, it is important to recognize the features of this unusual tumor.

METHODS

The authors present 8 new, fully characterized cases of HCCC and systematically reviewed 44 other cases of HCCC reported in the English language literature from 1980 to 2008. Historic cases were reviewed, and available data regarding morphology, special stains, demographics, clinical presentation, radiographic findings, management, and outcomes were extracted. Data from the current series were compared with the earlier published literature.

RESULTS

To the best of the authors' knowledge, this was the largest reviewed series of HCCC and included a total of 52 cases. The findings, which included key histologic features, clinical presentation, and outcome, generally were consistent with what was reported previously. However, the current review revealed that 25% of patients reported in the literature had metastatases at initial presentation, including 10 of 44 patients who had metastases to regional lymph nodes and 1 patient who had metastasis to the lung. The authors were unable to identify any specific histologic features that would predict this behavior.

CONCLUSIONS

The current results indicated that HCCC is less indolent than was believed previously; therefore, regional lymph node dissection should be considered in conjunction with wide local excision for patients with HCC.

Calcifying epithelial odontogenic tumor: an immunohistochemical case study

Calcifying epithelial odontogenic tumor (CEOT) is a rare benign odontogenic tumor. A case of CEOT in a 25-year-old female is presented here. Histologically, the case showed sheets of polyhedral epithelial cells with deep eosinophilic cytoplasm and prominent nuclei. Nuclear pleomorphism and hyperchromatism were evident. Globules of amyloid-like material among the tumor cells were prominent. Also found was a small area demonstrating a cribriform pattern. Immunohistochemical studies with antibodies against basement membrane proteins (laminins 1 and 5, collagen type IV and fibronectin), pan-cytokeratins AE1/AE3, vimentin, S-100 protein and CD 1a were performed. Tumor cells expressed laminins 1 and 5, fibronectin, cytokeratins and vimentin. The amyloid-like material was not reactive to all antibodies examined. A number of dendritic cells among sheets of tumor cells were revealed with strong staining for S-100 protein and CD 1a. These dendritic cells are likely to be Langerhans cells. Hence, immunohistochemistry is a useful method to study the variant of CEOT.

Cystic variant of calcifying epithelial odontogenic tumor

Calcifying epithelial odontogenic tumor (CEOT) is a benign, locally aggressive odontogenic neoplasm characterized by sheets and nests of epithelial cells with deeply eosinophilic or occasionally clear cytoplasm, calcifications, and eosinophilic amorphous material that stains positive for amyloid. Although many cases of CEOT are associated with impacted teeth and occasionally appear radiographically as dentigerous cysts, a true cystic variant has not been previously reported. We report a 15-year-old white male with a large cystic maxillary lesion that filled most of the left maxillary sinus. It deformed the medial wall, the inferior orbital floor, and caused narrowing of the left inferior meatus. Histologically, the cystic lining showed characteristics of CEOT. An intraluminal component that featured histologic characteristics of CEOT was identified during surgery. The lesion was enucleated and the postsurgical course of the patient was uneventful. Because follow-up has been for less than 1 year, a meaningful long-term prognosis cannot be determined at present. However, the patient has not reported any symptoms or signs of recurrence during the follow-up period.

Calcifying epithelial odontogenic tumour or Pindborg's tumour: features and behaviour in relation to a case

The calcifying epithelial odontogenic tumour (CEOT) or Pindborg's tumour is a rare benign odontogenic neoplasm composed of epithelioid cells, amorphous amyloid-like substance and calcifications. Its clinical and radiographical pictures are not characteristic depending upon the site, size and developmental stages in a range of its composition degeneration. A case of calcifying epithelial odontogenic tumour in the mandible is presented and the main aspects of the research about this tumour, such as the pathogenesis, histological features, developmental stages, malignancy, recurrence rate, differential diagnosis and therapeutic aspects are discussed.