Adenomatoid odontogenic tumor: a report of a rare case with recurrence

A case of large adenomatoid odontogenic tumor in the posterior region of the mandible showing root resorption

Introduction: Adenomatoid odontogenic tumor (AOT) is a rare tumor of epithelial origin, and usually presents as a unilocular radiolucency in the maxillary anterior region in adolescent females. Observation: A 31-year-old Japanese male, having a large adenomatoid odontogenic tumor from the right molar region to the left anterior region of the mandible showing root resorption of the neighboring teeth, was presented to the hospital. The lesion was totally resected under general anesthesia. Commentary: AOT may cause displacement of the neighboring teeth. But root resorption is a very rare finding. AOTs are relatively small in size. Conclusion: The patient was under follow-up and had not shown any signs of recurrence 12 months after surgery.

Multiple adenomatoid odontogenic tumours associated with eight impacted teeth

Adenomatoid odontogenic tumour (AOT) is a benign tumour that arises from odontogenic epithelial remnants. AOTs usually present as innocuous lesions with limited growth potential. Multiple AOTs are frequently reported in the literature, with reports of tumours associated with up to seven impacted teeth. Multiple AOTs have also been described in association with Schimmelpenning syndrome. This case report highlights the rare occurrence of multiple AOTs involving eight impacted teeth in a 9-year-old male patient. Radiographic examination showed features of enamel hypoplasia and multiple prominent dilated gubernaculum dentis associated with some of the impacted teeth. The patient also presented with a linear epidermal nevus involving the left face and intraoral mucosal papillomatous growths, clinical features highly compatible with Schimmelpenning syndrome.

Clinico-Pathological Presentations of Cystic and Classic Adenomatoid Odontogenic Tumors

The objective of the study is to present the clinico-pathological features of cystic and classic adenomatoid odontogenic tumors (AOTs) in order to identify the differences between the two variants of AOT. Materials and method: The study sample comprised of 41 AOTs, which were categorized into cystic and classic AOTs. Cystic AOTs are diagnosed as such when macroscopic and microscopic evidence of a cyst is present together with histopathological criteria of AOT (WHO–2017). Results: The study sample comprised of eleven cystic and thirty classic AOTs. Eight cystic AOTs were regarded as arising from dentigerous cysts as these lesions were attached to the cemento-enamel junction of the impacted teeth. Though not statistically significant, in contrast to classic AOTs which showed female predilection, cystic AOTs were more prevalent in males. Cystic AOTs tend to present as significantly larger lesions compared to classic AOTs (p < 0.02). In both cystic and classic AOTs, duct-like structures and epithelial whorls were the two most prominent histopathological features present in the majority of tumors. Two AOTs with massive amounts of dentinoid occurred in the mandible and presented as large lesions that eroded cortical bone. None of the 12 patients with follow-up information presented with recurrences. Conclusion: Except for the size of the lesion, no significant clinico-pathological differences were observed between cystic and classic AOTs. Therefore the cystic AOTs can be considered as a variant of AOT with enucleation, simple excision, or radical excision as the treatment of choice depending on the extent of the lesion, similar to classic AOTs.

Adenomatoid odontogenic tumor: An updated analysis of the cases reported in the literature

PURPOSE

To review the clinical and radiographic features of the available data published on adenomatoid odontogenic tumor (AOT) with special emphasis on the comparison of its variants.

METHODS

An electronic search was undertaken in July 2018. Eligibility criteria included publications having enough clinical/radiological/histological information to confirm the diagnosis.

RESULTS

A total of 436 publications reporting 1558 cases were included, of which 739 follicular, 247 extrafollicular, and 30 peripheral AOTs. Impacted canine is associated with follicular AOTs in almost 70% of the cases. AOTs were more prevalent in females, in the second decade of life, in maxillae, in anterior region of the jaws, and most are asymptomatic, with a considerable number of lesions presenting cortical bone perforation. Most of the lesions were treated by enucleation. Some cases of recurrence were reported in the literature, but only one was well documented. No difference was found when comparing the clinical/radiological features of the follicular, extrafollicular, and peripheral variants.

CONCLUSIONS

Adenomatoid odontogenic tumor variants do not show distinctive clinical radiological features. Recurrence of AOT is very rare, which justify its conservative management.

Adenomatoid odontogenic tumor: What is the true nature?

The Adenomatoid odontogenic tumor (AOT) is one of the most controversial benign odontogenic tumor, which has been known to the pathologists for the past 100 years. Since then the history, histogenesis and histopathologic designation of AOT remains a matter of debate. Some authors consider it as a true benign neoplasm while others consider it as a hamartoma and still others as an odontogenic cyst. Here we propose that the AOT should not be considered as a cyst because its true cystic nature remains questionable. We hypothesize that when the AOT arises from a change in REE covering of the impacted tooth, then it appears as cystic in nature & certainly not a true cyst by origin. Further studies on the histogenesis are required to change the nomenclature of AOT to adenomatoid odontogenic cyst (AOC).

Unusual Adenomatoid Odontogenic Tumor

The adenomatoid odontogenic tumor is a rare benign neoplasm. It can, however, have locally aggressive behavior. This is a case of an adenomatoid odontogenic tumor of unusual location and behavior in a 15-year-old female patient. A panoramic radiograph revealed a large radiolucent lesion involving the retained tooth 33. Teeth involved in this lesion were displaced and with apparent root resorption. A prototype of the mandible showed a marked expansion of cortical bone, fenestration points in the lingual cortex, and fragility of the base of the mandible. Therefore, because of the risk of postoperative pathologic fracture the placement of a 2.4-mm reconstruction plate was indicated. Total enucleation of the lesion, as well as placement of a reconstruction plate were performed. Despite the large bone destruction, with the correct surgical procedure and the use of the reconstruction plate the patient recovered without incidents and a 24-month postoperative radiography showed satisfactory bone formation.

A case report and short review on changing trends in the site of occurrence of adenomatoid odontogenic tumor: Unravelling the past 15 years

Adenomatoid odontogenic tumor (AOT) is an uncommon benign odontogenic lesion, with debatable histogenesis and variable histopathology. A systematic and diverse insight into the evolution, clinical presentation, histology, and immunohistochemical findings of this lesion is reviewed and presented. We reviewed the data published from 2000 to 2014 of approximately 255 cases that revealed a significant change in the incidence of predominant site involved, in contrast to the findings published by Reichart. We have also included the chronological order of events leading to the coining of the term AOT, which shows the curiosity that has been dedicated to understanding the lesion. Immunohistochemistry is considered to be a hallmark in pathology for learning the molecular pathogenesis and giving a correct final diagnosis. Several markers have been used to investigate and understand this lesion, and a compilation of the findings has been tabulated.

Adenoid ameloblastoma: clinicopathologic description of five cases and systematic review of the current knowledge

OBJECTIVE

To describe the clinicopathologic and immunohistochemical features of five cases of adenoid ameloblastoma.

STUDY DESIGN

Clinicopathologic data were gathered from medical records and compared with those compiled from a systematic review. Slides were also immunohistochemically stained for Ki-67, p16, p53, and cytokeratins (7, 8, 14, 18, and 19).

RESULTS

There were 3 males (60%) and 2 (40%) females. The mean age was 44 ± 10 years. Of the five adenoid ameloblastomas, 4 (80%) occurred in the posterior maxilla. Patients typically complained of asymptomatic swelling. All patients received surgical resection as primary therapy; 1 (20%) patient also received adjuvant radiotherapy. Recurrence was diagnosed in all patients. Immunohistochemically, the tumors stained focally positive for CK7, 8, 14, and 18 and diffusely positive for CK-19, p16, and p53. The mean Ki-67-positive cells were 72.4 ± 24.9 positive cells per high-power field (range 53-111).

CONCLUSIONS

To our knowledge, this is the largest series of adenoid ameloblastoma reported in the literature. Our data suggest that this entity demonstrates aggressive behavior characterized by a high likelihood of recurrence.

Adenomatoid Odontogenic Tumor (AOT) Arising from a Dentigerous Cyst: Literature Review and Report of a Case

Adenomatoid odontogenic tumor (AOT) is an uncommon benign tumor of odontogenic origin composed of odontogenic epithelium in a variety of histopathological patterns. These lesions are usually solid but are occasionally cystic. AOT has been reported to occur in association with odontogenic cysts. Very few cases have been described that arise in association with a dentigerous cyst. A systematic search of the English-language medical literature in PubMed and Medline search (keywords adenomatoid odontogenic tumor, dentigerous cyst) data bases revealed only ten such cases. The present case is very unique, exceptional and first of this kind that occurred in the posterior mandible associated with an impacted lower first premolar in a 19-year old female patient. The intraosseous follicular AOT, as this case reported here, frequently resemble dentigerous cysts. There is an uncertainty whether the lining of an associated cyst represents a true dentigerous cyst, cystic change within an AOT or may represent a distinct entity. We believe that this case represents an odontogenic cyst with neoplastic change. Hence, in such cases, the final diagnosis should be made on the basis of histological examination of extensive tissue sampling of entire excised tissue specimen. Further studies to determine whether the AOT derived from an odontogenic cyst could represent a distinct variant are to be done.

Adenomatoid odontogenic tumor of the mandible with unusual radiographic features: A case report

Adenomatoid odontogenic tumor (AOT) usually presents as a unilocular, pericoronal radiolucency in the maxillary anterior region in adolescent females. Very few conditions occur in such a narrow age range and at such a restrictive site. Rarely, these tumors present with varied clinical features. A case of AOT of the mandible is reported with unusual features such as large size, multilocular appearance, and aggressive behavior. The role of radiology in diagnosis of atypical AOT is extremely important. The unique radiological manifestations of the lesion helped in the diagnosis, and it was managed conservatively with no evidence of recurrence.

Adenoid ameloblastoma with dentinoid

Ameloblastomas seldom cause diagnostic difficulties due to classic histopathological presentations. Adenoid ameloblastoma is a rare variant in this category which can cause problem in diagnosis due to the presence of areas resembling adenomatoid odontogenic tumor (AOT) and occurrence of varying degrees of dentinoid formation. In this article, we report a case of adenoid ameloblastoma with dentinoid, which was diagnosed accurately after the third recurrence. To the best of our knowledge, so far, only 13 cases have been reported of tumors that histologically show features of amelobalstoma and AOT with hard tissue formation. The recurrences were due to under diagnosis of the lesion followed by a conservative treatment.

Critical evaluation of the radiological and clinical features of adenomatoid odontogenic tumour

OBJECTIVES

The aim of this study was to evaluate the radiological and clinical features of adenomatoid odontogenic tumours (AOTs).

METHODS

A total of 272 cases (267 from the English-language literature and 5 new cases) were analysed with special emphasis on their radiological features.

RESULTS

The patients' ages at time of diagnosis ranged from 3 years to 82 years (mean 18.4 years). The maxilla-to-mandible ratio was 1.7:1. Mandibular lesions were significantly more frequent among patients older than 16 years (p = 0.032). Expansion of the cortex was significantly more prominent among patients older than 16 years (p = 0.045). There was a positive correlation between the size of the lesion and the age of the patient at the time of diagnosis (p = 0.016). The size was also associated with increased root resorption (p < 0.001), ill-defined borders (p < 0.001), expansion (p < 0.001) and perforation of the cortex (p < 0.001). Small opacities were present in 77% of lesions and were associated with expansion of the cortex (p = 0.043). The significant radiological features in patients aged 30 years and above were root resorption (p = 0.013) and lesions crossing the midline (p = 0.019).

CONCLUSIONS

The size of an AOT is influenced by the patient's age. It is also associated with root resorption, ill-defined borders, expansion and perforation of the cortex, but it cannot be ruled out that those changes reflect a longer duration of the lesion.

Adenomatoid Odontogenic Tumor (AOT) Arising from a Dentigerous Cyst: Literature Review and Report of a Case

Adenomatoid odontogenic tumor (AOT) is an uncommon benign tumor of odontogenic origin composed of odontogenic epithelium in a variety of histopathological patterns. These lesions are usually solid but are occasionally cystic. AOT has been reported to occur in association with odontogenic cysts. Very few cases have been described that arise in association with a dentigerous cyst. A systematic search of the English-language medical literature in PubMed and Medline search (keywords adenomatoid odontogenic tumor, dentigerous cyst) data bases revealed only ten such cases. The present case is very unique, exceptional and first of this kind that occurred in the posterior mandible associated with an impacted lower first premolar in a 19-year old female patient. The intraosseous follicular AOT, as this case reported here, frequently resemble dentigerous cysts. There is an uncertainty whether the lining of an associated cyst represents a true dentigerous cyst, cystic change within an AOT or may represent a distinct entity. We believe that this case represents an odontogenic cyst with neoplastic change. Hence, in such cases, the final diagnosis should be made on the basis of histological examination of extensive tissue sampling of entire excised tissue specimen. Further studies to determine whether the AOT derived from an odontogenic cyst could represent a distinct variant are to be done.

Bilateral adenomatoid odontogenic tumour of the maxilla in a 2-year-old female--the report of a rare case and review of the literature

Multifocal odontogenic lesions are uncommon and have only been observed in conditions associated with known genetic mutations. To the best of our knowledge, only two cases of multifocal adenomatoid odontogenic tumours (AOT) have previously been reported in the literature. In this study, we report the first case of a bilateral, separate AOT in the maxilla in the midline in a 2-year-old female. The patient presented with bilateral expansile masses in the maxilla on either side of the midline which had been present for 6 months. She was asymptomatic and had occasional difficulty in breathing. The tumour was diagnosed as AOT and was surgically enucleated along with the associated teeth. The patient recovered well and has been on recall for 5 years. The follow-up panoramic radiograph made a fortnight ago revealed evidence of three new radio-opaque lesions with an associated tooth in the region of the anterior mandible, the premolar region of the right maxilla and the molar region of the left maxilla. To acquire additional information about AOT, all reports regarding AOT cited in 'PubMed' from 1995 onward were reviewed and the incidence, clinical features, radiographic features and management of AOT are discussed in this study.

Adenomatoid odontogenic tumour: tumour or a cyst, a histopathological support for the controversy

Adenomatoid odontogenic tumour (AOT) is a well-established odontogenic tumour with various clinicopathological variants. AOT quite frequently mimics an odontogenic cyst commonly a dentigerous cyst. Histologically a cystic component of AOT has been described in the literature. In the present paper we review the literature for the AOTs arising in an odontogenic cyst and add to the literature a case of cystic AOT. The present review is aimed to provide an insight to the varied demographic profile, clinical behavior and prognosis of cystic variant of AOT.

Adenomatoid odontogenic tumor - hamartoma or true neoplasm: a case report

Adenomatoid odontogenic tumor (AOT) is an uncommon tumor of odontogenic origin with a relative frequency of 2.2 - 7.1%. As the histogenesis of AOT is still uncertain, it is sometimes categorized as a hamartomatous lesion rather than a true neoplasm. We report a case of AOT in the right maxillary anterior region in a 20-year-old woman. The tumor showed some unusual and aggressive features that suggested it was a true neoplasm.

Diagnostically challenging epithelial odontogenic tumors: a selective review of 7 jawbone lesions

Considerable variation in the clinicopathologic presentation of epithelial odontogenic tumors can sometimes be confusing and increase the chance of misdiagnosis. Seven diagnostically challenging jawbone lesions are described. There were 2 cases of mistaken identity in our ameloblastoma file. One unicystic type, initially diagnosed and treated as a lateral periodontal cyst, showed destructive recurrence 6 years postoperatively. The other globulomaxillary lesion was managed under the erroneous diagnosis of adenomatoid odontogenic tumor and recurred 4 times over an 11-year period. This tumor was found in retrospect to be consistent with an adenoid ameloblastoma with dentinoid. The diagnosis of cystic squamous odontogenic tumor (SOT) occurring as a radicular lesion of an impacted lower third molar was one of exclusion. Of two unsuspected keratocystic odontogenic tumors, one depicted deceptive features of pericoronitis, while the other case has long been in our files with the diagnosis of globulomaxillary SOT. Two cases of primary intraosseous squamous cell carcinoma appeared benign clinically and exhibited unexpected findings; an impacted third molar began to erupt in association with the growth of carcinoma and another periradicular carcinoma showed dentinoid formation. Cases selectively reviewed in this article present challenging problems which require clinical and radiographic correlation to avoid potential diagnostic pitfalls.