Aberrant gene expression in epithelial cells of mixed odontogenic tumors

Adenoid ameloblastoma with dentinoid: A rare hybrid odontogenic tumor

BACKGROUND

Adenoid ameloblastoma with dentinoid (AAD) is a hybrid odontogenic tumor comprising histopathological presentation of ameloblastoma (AM) and adenomatoid odontogenic tumor (AOT) along with extracellular dentinoid material.

CASE PRESENTATION

A 35-year-old female reported an asymptomatic swelling in the left mandibular posterior region. Histopathological examination revealed composite features of AM with AOT along with dentinoid material, which stained positively with Van Gieson and trichrome stains.

CONCLUSION

The present case report serves to add further to the modicum of literature reports pertaining to AAD, which may gain recognition as a distinct entity in future World Health Organization (WHO) classification of odontogenic tumors.

Complex Odontoma at an Unusual Site in a Child: A Case Report

Odontomas are known as the most common odontogenic tumor and usually present without clinical symptoms. It can be divided into compound odontoma and complex odontoma. Compound odontomas are calcified tissue and they bear similarity to the teeth, whereas complex odontomas do not show similarity to the tooth. Diagnosis of the odontomas is usually accidental on radiographic examination. Complex odontomas are commonly seen in the posterior mandible. Apart from the few case reports regarding the complex odontoma of the anterior mandibular region, reported occurrence in this site is rare. Here, authors described a case of a child who presented with a chief complaint of swelling in the anterior mandibular canine region. After clinical examination and required investigations, provisionally, it was diagnosed as complex odontoma. It was surgically removed and histopathological examination confirmed the provisional diagnosis.

How to cite this article: Ahammed H, Seema T, Cheranjeevi J. Complex Odontoma at an Unusual Site in a Child: A Case Report. Int J Clin Pediatr Dent 2021;14(3):438–440.

Odontogenic carcinosarcoma with dentinoid: a rare case report

Odontogenic carcinosarcoma is a very rare malignant odontogenic tumor, characterized by malignant epithelial and mesenchymal components. Studies have reported several cases of odontogenic carcinosarcoma, mainly in the upper and lower jaws, with malignant clinical manifestations. Herein, we present the case of a 58-year-old woman with odontogenic carcinosarcoma with dentinoid in the left maxilla. The invasion range was large, and the left maxillary molar was missing. Histology revealed odontogenic carcinosarcoma with bidirectional differentiation characteristics and comprising three components: malignant epithelium, malignant interstitium, and dentinoid. The patient subsequently underwent nasal endoscopic sinus tumor resection, and she recovered well after surgery. After a strict 4-year follow-up, to date, there are still no signs of disease or local recurrence. To our knowledge, this is the first reported case of odontogenic carcinosarcoma with dentinoid. Our study describes the clinical, morphological, and immunohistochemical characteristics of this case, and distinguishes it from related diseases.

Analysis of Protein Immunoexpression and Its Interrelationship in the Pathogenesis of Odontomas and Ameloblastic Fibro-Odontomas: A Systematic Review

Odontomas and ameloblastic fibro-odontomas (AFOs) are the result of a developmental anomaly of odontogenic tissues. A literature review of proteins immunoexpressed in odontomas and AFOs was conducted in order to determine which proteins are involved in the pathogenesis of these lesions. AFO was changed to early odontoma in the 2017 WHO classification and will also be discussed in this article. A literature search was performed in the following electronic databases: PubMed/MEDLINE, Web of Science, Scopus, EMBASE, Lilacs, Cochrane Collaboration Library, and Science Direct. The research question was developed according to the population, intervention, comparison, and outcome (PICO) framework: Which proteins are related to the differentiation of odontomas and what is their interrelationship with AFOs? Thirty articles met all inclusion criteria and were selected for this systematic review, totaling 355 cases of odontomas and 43 cases of AFO. Similar immunoexpression was observed in odontomas and AFOs. Immunoexpression of proteins involved in cell differentiation was higher in compound odontomas than in complex odontomas. Proteins involved in histodifferentiation and enamel formation were more frequent in odontomas. The immunoexpression of enamel matrix proteins differs between odontomas and tooth germs, with their persistence being related to the development of odontomas. Compound odontomas exhibit the highest immunoexpression of proteins involved in cellular histodifferentiation and the Wnt/beta-catenin pathway is involved in tumor formation.

Amelogenin in calcified matrices of odontogenic cysts and odontogenic tumors: An immunohistochemical study

Background/purpose

There are few studies comparing the expression of enamel proteins, such as amelogenin, and cytokeratins in cyst and odontogenic tumors like in ameloblastoma and odontogenic keratocyst, indicating that amelogenin could be a potential biomarker for the aggressiveness in the odontogenic tumors. The aim of this study was to evaluate if the expression of amelogenin, cytokeratin AE1/AE3 (CKAE1/AE3) and cytokeratin 14 (CK14) in cysts and odontogenic tumors with calcified matrices such as calcifying odontogenic cyst (COC), compound (CdO) and complex (CxO) odontomas, adenomatoid odontogenic tumor (AOT) and calcifying epithelial odontogenic tumor (CEOT) as an aggressiveness indicator.

Materials and methods

Three COC, eight CxO, three CdO, twelve AOT, two CEOT and three dental germs were submitted to an immunohistochemistry panel of antibodies composed of amelogenin, CKAE1/AE3 and CK14.

Results

CKAE1/AE3 and CK14 was present in all odontogenic epithelia. The amelogenin protein was detected in prismatic and amorphous calcified matrices of epithelial origin belonging to CxO, CdO, AOT, COC and the tooth germs used as controls. On the other hand, the CEOT was the only tumor or cyst studied that did not present immunostaining for amelogenin in calcified matrices.

Conclusion

Amelogenin was detected in pathologies with a low or absent recurrence rate and excellent prognosis. CEOT was the lesion of greater clinical aggressiveness which did not express amelogenin. The presence of amelogenin in calcified matrices of odontogenic arise could be an indicator of low aggressiveness.

Atypical Intracranial Compound Simil Odontoma

Odontoma is the most common mixed epithelial and mesenchymal tumour-like malformation which affects maxillary bones. Clinically, Odontomas present as lesions of benign behavior, causing little or no deformity, are asymptomatic, with self-limited growth and usually detected on routine radiographs. Radiographically, they are radiopaque lesions, well-demarcated surrounded by a thin soft tissue capsule. Compound odontomas consist of numerous tooth-like structures, whereas in complex odontomas it consists of a disorganized mass of calcified tissue. The aim of this article was to report an atypical case of intracranial compound odontoma, in the middle cranial fossa, reaching the sphenoidal sinus, which has been followed for 10 years.

Amelogenin is a Potential Biomarker for the Aggressiveness in Odontogenic Tumors

Amelogenin (AMEL), the major structural protein of the enamel organic matrix, constitutes more than 90% of the enamel’s protein content, Aberrations of amelogenin are thought to be involved in the oncogenesis of odontogenic epithelium. The expression of amelogenin is possibly an indicator of differentiation of epithelial cells in the odontogenic tumors. Aim of the study: Investigating the expression of amelogenin in some odontogenic tumors, using an anti-amelogenin polyclonal antibody, and then compare it with AMEL expression in tooth buds as control. Materials and Methods: study sample consisted of 10 formalin-fixed, paraffin- embedded specimens of ameloblastoma, 10 Keratocystic odontogenic tumors, and 10 tooth buds were conventionally stained with hematoxylin-eosin and immunohistochemically with AMEL polyclonal antibody. Results: All of the odontogenic tumors expressed AMEL in the epithelial component, Intensity of expression in ameloblastoma and Keratocystic odontogenic tumor was lower, compared with tooth buds, Statistical analysis indicated a significant differences between the tumors and tooth buds. Conclusion: Amelogenin can be used as a marker for odontogenic epithelium, and the expression of amelogenin is possibly an indicator of epithelial cells differentiation in the odontogenic tumors, and therefore in prediction of the histological behavior of odontogenic tumors.

Adenoid ameloblastoma with dentinoid: A rare hybrid variant

Odontogenic tumors comprise an unusual group of lesions of the jaw and present diverse histological patterns. Derived from the primordial tooth-forming tissues, they represent a heterogeneous group of lesions that range from hamartomas to benign and malignant neoplasms of variable aggressiveness. Sporadic case reports and diverse complex histogenetic source also defy categorization of odontogenic tumors. Many can be diagnosed accurately based on the distinctive clinical, radiological and histopathological presentation. Considerable variations in the clinicopathological presentation of odontogenic tumors can be confusing, increasing the chance of misdiagnosis. An interesting case of adenoid ameloblastoma reported in a 55-year-old male patient in the mandible, presenting with a diverse and intriguing histopathology, is discussed here.

Mouse Amelogenin Exons 8 and 9: Sequence Analysis and Protein Distribution

Amelogenin is the major protein of the developing enamel. Two additional exons, termed 8 and 9, have been characterized in the rat. Our aim was: to identify the mouse amelogenin exons 8/9 sequences; to investigate the potential presence of the alternative spliced isoforms of amelogenin exons 8/9; and to immunolocalize proteins containing sequences encoded by exons 8/9 during odontogenesis. RT-PCR analysis with exon 9 anti-sense primer generated 2 major amplicons with the use of a mouse tooth cDNA library and dental cell lines. DNA sequence analysis showed 93% identify with the rat exons 8/9 sequence. Alternative splicing of exon 3 was also found, but only in cDNAs lacking exons 8 and 9. Immunohistochemistry localized exons 8/9-encoded proteins in ameloblasts, young odontoblasts, and stratum intermedium cells. Analysis of our data supports the hypothesis that: (1) AMELX contains 2 additional exons; (2) ameloblasts and odontoblasts synthesize amelogenin 8/9; and (3) amelogenin splice variants may have unique functions during tooth formation.

Management of a massive compound odontoma in a 9-year child

The purpose of this paper is to describe the case of surgical management of massive compound odontoma with 36 denticles in a 9-year-boy who presented with a complaint of pain and swelling in mandibular left posterior region and retained 74. The denticles were removed after the removal of retained 74 completely and wound healing was observed. Odontomas are considered as hamartomatous dental malformation rather than true neoplasm of odontogenic origin. They are the most commonly occurring abnormally formed dental tissues that interfere with eruption of associated teeth. The eruption disturbances seen due to odontomas are delayed eruption or deflection of associated teeth. These malformations are usually asymptomatic and discovered during routine radiographic investigations. Correct diagnosis followed by proper treatment plan results in a favorable prognosis.

Odontomas and supernumerary teeth: is there a common origin?

The aim of the present work is to analyze all scientific evidence to verify whether similarities supporting a unified explanation for odontomas and supernumerary teeth exist. A literature search was first conducted for epidemiologic studies indexed by PubMed, to verify their worldwide incidence. The analysis of the literature data shows some interesting similarities between odontomas and supernumerary teeth concerning their topographic distribution and pathologic manifestations. There is also some indication of common genetic and immuno-histochemical factors. Although from a nosological point of view, odontomas and supernumeraries are classified as distinct entities, they seem to be the expression of the same pathologic process, either malformative or hamartomatous.

A peripheral ameloblastic fibro-odontoma in a 3-year-old girl: case report, immunohistochemical analysis, and literature review

Ameloblastic fibro-odontoma (AFO) predominantly occurs in the jaw bones of children and young adults. Extraosseous AFO is extremely rare. We describe a peripheral ameloblastic fibro-odontoma in the maxillary gingiva of a 3-year-old girl. The clinical appearance resembled fiery red reactive gingival lesions. The histopathological examination of the excised lesion showed small islands and cords of odontogenic epithelium with cellular myxoid stroma in the subepithelial tissue. The mass contained calcified material and an enamel-like deposit. Many small blood vessels appeared in the connective tissue surrounding the odontogenic epithelium. The immunohistochemical assays showed strong reactivity for amelogenin, β-catenin, CD44, and CD31 in the tissue sections. There was no recurrence after the 1-year follow-up. Because this lesion clinically resembles other nonneoplastic lesions and is very rare in gingiva, establishing a correct diagnosis is achieved only based on specific histological characteristics. Conservative excision of the tumor is the treatment of choice.

The complexity of stromal changes in desmoplastic ameloblastoma

Ameloblastoma is usually considered a homogenous neoplasm and is thought of as the most primitive of all odontogenic neoplasms. However, detailed investigations have proven clinicopathological diversity in a significant number of cases, thus mounting the evidence in favor of considering ameloblastoma as a mysterious lesion. The purpose of this article is to report a unique case of desmoplastic ameloblastoma and to throw light on the atypical changes noticed in the stromal component. The findings of this case have served to add interesting parameters to the study of stromal changes associated with this perplexing odontogenic tumor.

Erupted compound odontome

Odontomas are considered to be hamartomas rather than a true neoplasm. They consist chiefly of enamel and dentin, with variable amount of pulp and cementum when fully developed. They are generally asymptomatic and are included under the benign calcified odontogenic tumors. They are usually discovered on routine radiographic examination. Eruption of an odontoma in the oral cavity is rare. Peripheral compound odontomas arise extraosseously and have a tendency to exfoliate. In this article we are reporting a case of a 15-year-old girl with peripheral compound odontoma, with a single rudimentary tooth-like structure in the mandibular right second molar region, which is about to be exfoliated. Its eruption in the oral cavity and location in the mandibular posterior region is associated with aplasia of the mandibular right second molar, making it an interesting case for reporting.

Amelogenin: A novel protein with diverse applications in genetic and molecular profiling

Tooth enamel is a unique entity among all mineralized tissues because of the presence of high mineral content. It is non collagenous and does not undergo resorption and remodelling. Its formation occurs through a transient collaborating network of enamel matrix proteins which controls hydroxyapatite crystal growth and orientation. Amelogenins constitute about 90% of the total enamel matrix proteins and play a major role in enamel bio mineralization. Amelogenin isoforms coalesce into nanospheres thus dictating the width and thickness of apatite crystals. The X and Y copies of amelogenins do not undergo homologous recombination, thus preferring it for sex determination in modern forensics. Recently, it was discovered that application of amelogenin to diseased periodontal tissue surfaces enhanced the regeneration of all the periodontal tissues. Additionally, low molecular mass amelogenin polypeptides have also been thought to possess osteogenic potential. Recent data regarding usage of immunohistochemical markers for mesenchymal stem cells suggested that amelogenin has the capacity to induce the recruitment of mesenchymal stem cells directly or indirectly during regeneration of the supporting periodontal tissues. Thus, our current concepts of dental enamel formation should be reviewed thoroughly so that this information could be applied to clinical circumstances where this understanding may be particularly relevant.

From the transcription of genes involved in ectodermal dysplasias to the understanding of associated dental anomalies

Orodental anomalies are one aspect of rare diseases and are increasingly identified as diagnostic and predictive traits. To understand the rationale behind gene expression during tooth or other ectodermal derivative development and the disruption of odontogenesis or hair and salivary gland formation in human syndromes we analyzed the expression patterns of a set of genes (Irf6, Nfkbia, Ercc3, Evc2, Map2k1) involved in human ectodermal dysplasias in mouse by in situ hybridization. The expression patterns of Nfkbia, Ercc3 and Evc2 during odontogenesis had never been reported previously. All genes were indeed transcribed in different tissues/organs of ectodermal origin. However, for Nfkbia, Ercc3, Evc2, and Map2k1, signals were also present in the ectomesenchymal components of the tooth germs. These expression patterns were consistent in timing and localization with the known dental anomalies (tooth agenesis, microdontia, conical shape, enamel hypoplasia) encountered in syndromes resulting from mutations in those genes. They could also explain the similar orodental anomalies encountered in some of the corresponding mutant mouse models. Translational approaches in development and medicine are relevant to gain understanding of the molecular events underlying clinical manifestations.

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).

Immunohistochemical expression of Rho GTPases in ameloblastomas

Rho GTPases are proteins that regulate cell cycle, shape, polarization, invasion, migration, and apoptosis, which are important characteristics of normal and neoplastic cells. Rho GTPases expression has been reported in normal tooth germ and several pathologies; however, it has not been evaluated in ameloblastomas. The aim of this study was to analyze the expression and distribution of RhoA, RhoB, Rac1, and Cdc42 Rho GTPases in solid and unicystic ameloblastomas. Three-micrometer sections from paraffin-embedded specimens were evaluated by using an avidin-biotin immunohistochemical method with antibodies against the proteins mentioned above. RhoA and RhoB staining was observed in a high number of cells (P < 0.05) and greater intensity in non-polarized ones. Rac1 was not observed, and Cdc42 did not show any statistical differences between the number of non-polarized and basal positive cells (P > 0.05). Upon comparing the studied ameloblastomas, a higher number of positive cells in the unicystic variant was observed than that in the solid one (P < 0,05). The results obtained suggest that these GTPases could play a role in the ameloblastoma neoplastic epithelial cell phenotype determination (polarized or non-polarized), as well as in variant (solid or unicystic) and subtype (follicular or plexiform) determination. Furthermore, they could participate in solid ameloblastoma invasion mechanisms.

Loss of heterozygosity (LOH) in tumour suppressor genes in benign and malignant mixed odontogenic tumours

Although molecular alterations are reported in different types of odontogenic tumours, their pathogenesis remains to be established. Loss of heterozygosity (LOH) studies allow the identification of minimal regions of deletions of known or putative tumour suppressor genes, the losses of which may promote neoplastic growth. The purpose of this study was to investigate LOH in a set of odontogenic mixed tumours. Tumour suppressor gene loci on 3p, 9p, 11p, 11q and 17p chromosomes were analysed in five samples of ameloblastic fibroma (AF), three samples of ameloblastic fibro-odontoma (AFO) and three samples of ameloblastic fibrosarcoma (AFS). The most frequently lost genetic loci were p53 (17p13, 62%) and CHRNB1 (17p13, 55%). LOH at the chromosome regions 3p24.3, 9p22 and 9p22-p21 was identified only in AFS. No sample showed LOH at the chromosomal loci 3p21.2 and 11q13.4. For the region 9p22-p13, LOH occurred in one sample of AFO. The fractional allelic loss (FAL) was calculated for each sample. The mean FAL of the benign lesions (i.e. AF and AFO) was 22%, whereas the mean FAL of the malignant lesions (i.e. AFS) was 74.6%. In conclusion, our results show a higher FAL in AFS compared to its benign counterparts and reveal a different pattern of LOH of tumour suppressor genes in AFS, which may regulate changes in tumour behaviour.

Tributyltin alters osteocalcin, matrix metalloproteinase 20 and dentin sialophosphoprotein gene expression in mineralizing mouse embryonic tooth in vitro

We showed in a previous in vitro study that tributyltin (TBT) arrests dentin mineralization and enamel formation in developing mouse tooth. The present aim was to investigate the effect of TBT on the expression of genes associated with mineralization of dental hard tissues. Embryonic day 18 mouse mandibular first molars were cultured for 3, 5 or 7 days and exposed to 1.0 μM TBT and studied by real-time quantitative polymerase chain reaction (RT-QPCR) for the expressions of osteocalcin (Ocn), alkaline phosphatase (Alpl), dentin matrix protein 1 (Dmp1), dentin sialophosphoprotein (Dspp) and matrix metalloproteinase 20 (Mmp-20).Ocn, Mmp-20 and Dspp, whose expressions showed changes in RT- QPCR, were further analyzed by in situ hybridization of tissue sections. In situ hybridization showed that TBT decreased Ocn expression in odontoblasts but increased the expression in the epithelial tooth compartment. In QPCR assays, the net effect in the whole tooth was increased expression. TBT also reduced Mmp-20 expression in ameloblasts and odontoblasts. Dspp expression varied but both QPCR assays and in situ hybridization showed a decreasing trend. TBT exposure had no clear effect on Alpl and Dmp1 expressions. Increased Ocn expression by epithelial enamel organ may inhibit dentin mineralization and enamel formation. Decreased Ocn, Mmp-20 and Dspp expressions in odontoblasts may indicate delayed cell differentiation, or TBT may specifically decrease the expression of genes involved in dentin mineralization. While decreased Mmp-20 expression by TBT in ameloblasts may impair enamel mineralization, the coincident reduction in Mmp-20 and Dspp expressions in odontoblasts may potentiate the delay of dentin mineralization.

Odontome: A Brief Overview

Odontomas are the most common type of odontogenic tumors. They are included under the benign calcified odontogenic tumors. Odontomas are basically classified into two types, complex and compound odontomes. Various theories or etiological factors are been quoted for the occurrence of odontomes. Generally, they are asymptomatic. Occasionally, signs and symptoms relating to their presence do occur. The sole management depends upon the early diagnosis, histopathological examination and excision of these tissues. This article briefs regarding its classification, etiological factors, occurrence, differences between complex and compound odontomes, diagnosis and management.

[Maxillary and mandibular carcinogenesis: research and prospects]

Development and growth of odontogenic tumours depend on impairment of numerous genes and molecules. In recent years, most of the genes involved in dental development were identified. This produced a new basis for the study of oral pathology and maxillofacial carcinogenesis. A better understanding of these molecular phenomena should allow to better determine the evolution of such lesions. Research breakthroughs should facilitate the development of new molecular and genetic therapeutic perspectives.

Msx and dlx homeogene expression in epithelial odontogenic tumors

Epithelial odontogenic tumors are rare jaw pathologies that raise clinical diagnosis and prognosis dilemmas notably between ameloblastomas and clear cell odontogenic carcinomas (CCOCs). In line with previous studies, the molecular determinants of tooth development-amelogenin, Msx1, Msx2, Dlx2, Dlx3, Bmp2, and Bmp4-were analyzed by RT-PCR, ISH, and immunolabeling in 12 recurrent ameloblastomas and in one case of CCOC. Although Msx1 expression imitates normal cell differentiation in these tumors, other genes showed a distinct pattern depending on the type of tumor and the tissue involved. In benign ameloblastomas, ISH localized Dlx3 transcripts and inconstantly detected Msx2 transcripts in epithelial cells. In the CCOC, ISH established a lack of both Dlx3 and Msx2 transcripts but allowed identification of the antisense transcript of Msx1, which imitates the same scheme of distribution between mesenchyme and epithelium as in the cup stage of tooth development. Furthermore, while exploring the expression pattern of signal molecules by RT-PCR, Bmp2 was shown to be completely inactivated in the CCOC and irregularly noticeable in ameloblastomas. Bmp4 was always expressed in all the tumors. Based on the established roles of Msx and Dlx transcription factors in dental cell fates, these data suggest that their altered expression is a proposed trail to explain the genesis and/or the progression of odontogenic tumors.

Distal cis-regulatory elements are required for tissue-specific expression of enamelin (Enam)

Enamel formation is orchestrated by the sequential expression of genes encoding enamel matrix proteins; however, the mechanisms sustaining the spatio-temporal order of gene transcription during amelogenesis are poorly understood. The aim of this study was to characterize the cis-regulatory sequences necessary for normal expression of enamelin (Enam). Several enamelin transcription regulatory regions, showing high sequence homology among species, were identified. DNA constructs containing 5.2 or 3.9 kb regions upstream of the enamelin translation initiation site were linked to a LacZ reporter and used to generate transgenic mice. Only the 5.2-Enam-LacZ construct was sufficient to recapitulate the endogenous pattern of enamelin tooth-specific expression. The 3.9-Enam-LacZ transgenic lines showed no expression in dental cells, but ectopic beta-galactosidase activity was detected in osteoblasts. Potential transcription factor-binding sites were identified that may be important in controlling enamelin basal promoter activity and in conferring enamelin tissue-specific expression. Our study provides new insights into regulatory mechanisms governing enamelin expression.

Genetische Störungen der Zahnentwicklung und Dentition

Die Zähne sind Organe, die aus ektodermalen epithelialen Aussackungen im Bereich des 1. Kiemenbogens entstehen, gesteuert von epitheliomesenchymalen Interaktionen. Dabei spielen zahlreiche Signalmoleküle speziell der 4 großen Familien TGF-β, FGF, Hedgehog und WNT sowie diverse Transkriptionsfaktoren eine Rolle. Eine Beteiligung der Retinoide an der Odontogenese ist durch umfangreiche Befunde belegt, auch wenn die Inaktivierung relevanter Gene in Mausmodellen meist keine Zahnanomalien verursacht. Die Zahnentwicklung wird klassischerweise in verschiedene Stadien eingeteilt: Entstehung der Zahnleiste, der Zahnknospe, der Schmelzkappe, der Schmelzglocke, die Wurzelbildung und der Zahndurchbruch. Anomalien der Zahnentwicklung können isoliert oder gemeinsam mit anderen Symptomen im Zusammenhang mit Syndromen auftreten. Sie können genetisch bedingt sein oder unter Einwirkung teratogener Stoffe während der Bildung und Mineralisierung der Zahnkeime zustande kommen. Dentibukkale Entwicklungsanomalien treten im Kontext seltener Erkrankungen auf und finden zunehmend Beachtung, da sie bei bestimmten Erkrankungen in der Diagnostik und als prädikative Faktoren wichtige Anhaltspunkte geben können. Allerdings ist hierfür eine interdisziplinäre und internationale Kooperation notwendig, die bislang erst in Ansätzen verwirklicht wurde.

Molecular pathology of odontogenic tumors

Odontogenic tumors are lesions derived from the elements of the tooth-forming apparatus and are found exclusively within the jawbones. This review represents a contemporary outline of our current understanding of the molecular and genetic alterations associated with the development and progression of odontogenic tumors, including oncogenes, tumor-suppressor genes, oncoviruses, growth factors, telomerase, cell cycle regulators, apoptosis-related factors, regulators of tooth development, hard tissue-related proteins, cell adhesion molecules, matrix-degrading proteinases, angiogenic factors, and osteolytic cytokines. It is hoped that better understanding of related molecular mechanisms will help to predict the course of odontogenic tumors and lead to the development of new therapeutic concepts for their management.

Analysis of amelogenin gene (AMGX, AMGY) expression in ameloblastoma

Although the amelogenin gene is expressed in ameloblastoma, the precise expression pattern of X and Y amelogenin genes (AMGX, AMGY) in this tumor has not yet been identified. In this study, we analyzed amelogenin gene expression in 19 samples (9 male, 10 female) of oral ameloblastomas by RT-PCR and detect the chromosomal origin of amelogenin mRNA by restriction enzyme digestion of the RT-PCR product. All tumor samples expressed amelogenin mRNA. We could detect increased level of AMGY expression in all male samples, higher than that of AMEX. It is an interesting finding as in normal male tooth development, the expression of AMGY is very much lower than that of AMGX. We postulate that epigenetic change of sex chromosomes may have some correlations with tumorigenesis of ameloblastoma. We also discuss the other possible mechanisms and points for future studies on this change in expression pattern.

mRNA expression and phenotype of odontogenic tumours in the v-Ha-ras transgenic mouse

Ameloblastomas are the most common odontogenic neoplasia in humans, and although typically considered locally invasive and benign, frequently recur subsequent to surgical resection. The Tg.AC transgenic mouse carrying the v-Ha-ras oncogene has been found to spontaneously develop ameloblastoma-like tumours (35% by 1 year of age) that are rare in the wild type FVB background strain.

OBJECTIVE

The purpose of this study was to characterise the mRNA expression of genes in the mouse tumours that are either expressed in human ameloblastomas or essential for normal odontogenesis and to correlate the expression to the histological phenotype.

STUDY METHODS

Histological, immunohistochemical and RT-PCR studies were used to evaluate clinically demonstrable odontogenic tumours occurring spontaneously in seven Tg.AC v-Ha-ras transgenic mice (homozygous, at 7 months of age or heterozygous at 11 months of age).

RESULTS

Most genes profiled were expressed in all tumour samples, however three (amelogenin, matrix metalloproteinase-20 (MMP-20) and Dlx7) displayed differential expression. In addition, only the most highly differentiated tumour stained positively for collagen. In most cases, the variable expression could be explained by reference to the histological phenotype, although differences in gene expression were apparent within the Type 2 and the mixed phenotype tumours.

CONCLUSIONS

These data confirm that many of the genes thought to be important in odontogenesis and odontogenic tumour formation in humans are also expressed in these murine ameloblastoma-like tumours however genes associated with terminal differentiation of ameloblasts demonstrate differential expression between the tumour phenotypes.

Proteomic analysis of dental tissues

Teeth are highly refined structures formed by several types of specialised cell. Tooth formation embraces many areas of biomedical interest, including cellular mechanisms for calcium handling, protein secretion and mineralised tissue production. Proteomics offers great potential to elucidate these cellular roles, and to establish their relevance to general cell types. Here we review our proteomic investigations of dental enamel formation, covering both the approaches taken and some findings of general biomedical relevance.

Clear cell odontogenic carcinoma. Report of two cases and review of the literature

This study reviews the literature and reports on the morphologic and immunophenotypic features of 2 clear cell odontogenic carcinomas occurring in the mandible of elderly women, showing extensive infiltration into adjacent tissues. The tumor cells were large, with clear cytoplasm, and arranged in irregular sheets. Some of the latter demonstrated a peripheral rim of cells with eosinophilic cytoplasm or included duct-like structures. There was no evidence of ameloblastic differentiation. Most cells contained glycogen granules and were immunoreactive for cytokeratins and epithelial membrane antigen. In the differential diagnosis other clear cell odontogenic, salivary gland, and metastatic tumors should be considered. Both cases were treated with surgical excision, and the patients are free of disease after 3 and 5 years, respectively. In the literature, however, variable behavior of these tumors has been reported, including recurrence and metastases. It is recommended that terms such as clear cell ameloblastoma and clear cell odontogenic tumor not be used to describe such tumors.

Use of calretinin in the differential diagnosis of unicystic ameloblastomas

AIMS

Calretinin, a 29-kDa calcium-binding protein is expressed widely in normal human tissues and tumours including both unicystic and solid and multicystic ameloblastomas. The histological distinction between unicystic ameloblastomas and certain non-neoplastic odontogenic cysts can be problematic. The objective of this study was to determine whether calretinin was expressed in the lining epithelium of odontogenic keratocysts, residual and dentigerous cysts and to determine whether this calcium-binding protein could be used to distinguish these cysts from the unicystic ameloblastoma.

METHODS AND RESULTS

The lining epithelium in 22 cases of odontogenic keratocyst, 26 cases of residual cyst and 20 cases of dentigerous cyst were examined for the expression of calretinin. No positive epithelial staining was observed in any of these cystic lesions. In comparison, however, 81.5% of cases of unicystic ameloblastoma showed a coarse dark brown staining of the more superficial epithelial cell layers. Scattered positive stromal and epithelial cells were present; these were interpreted as mast cells.

CONCLUSIONS

Calretinin appears to be a specific immunohistochemical marker for neoplastic ameloblastic epithelium and we suggest that it may be an important diagnostic aid in the differential diagnosis of cystic odontogenic lesions and ameloblastic tumours.

A case of an ameloblastic fibro-odontoma arising from a calcifying odontogenic cyst

This case report describes an ameloblastic fibro-odontoma arising from a calcifying odontogenic cyst (COC) in the mandible of a twenty-three-year old male. The patient was referred to the Department of Oral Surgery, Tokyo Dental College, on March 30th, 2000, complaining of a painful swelling, which had appeared three weeks earlier on his left mandibular molar region. In a pathological view, the lesion was a round cyst the size of a chicken-egg, dark red in color, and surrounded by a thick membrane. The cyst had an epithelium of varying thickness which included many ghost cells and an enamel-like structure on the inside, and a thick wall of connective tissue with an ameloblastic fibro-odontoma on the outside. Enamel organ-like epithelial islands were structured radially in the form of strands with immature dentin. Cytokeratin 19 was strongly immunoreactive in the epithelium of the lesion; osteopontin and osteocalcin reacted in the mesenchymal cells and weakly in the epithelial element of this tumor.

Ghost cells in calcifying odontogenic cyst express enamel-related proteins

The so-called ghost cell is a unique cell type occurring in a variety of odontogenic and non-odontogenic lesions. However, the true nature of ghost cells has not been determined. In the present study, we examined the immunoreactivity of ghost cells in calcifying odontogenic cysts and dermal calcifying epitheliomas, with antibodies against amelogenin, enamelin, sheath protein (sheathlin) and enamelysin, in an attempt to clarify the nature of this unique cell. The cytoplasm of ghost cells in calcifying odontogenic cysts demonstrated distinct immunolocalization of the enamel-related proteins, while similar in the calcifying epitheliomas of the skin showed a negative reaction. The results indicate that the ghost cells in calcifying odontogenic cysts, as opposed to ghost cells in dermal calcifying epitheliomas, contain enamel-related proteins in their cytoplasm accumulated during the process of pathological transformation.

Selective but nonspecific immunolabeling of enamel protein-associated compartments by a monoclonal antibody against vimentin

Vimentin, an intermediate filament component, has been identified in many mesenchymal cells by a variety of LM and EM immunolabeling techniques. In our study, several tissue-processing conditions and monoclonal and polyclonal antibodies against vimentin were screened for immunostaining of rat incisor odontoblasts. Using postembedding colloidal gold immunocytochemistry, we were unable to detect any convincing vimentin antigenicity in these cells, but one of the monoclonal antibodies (V9-S) unexpectedly resulted in intense labeling over intra- and extracellular compartments that normally are strongly immunoreactive with anti-amelogenin antibodies. Blocking experiments showed that V9-S binding was competed by anti-amelogenin antibody. Immunoblots indicated that enamel proteins reacted with this anti-vimentin antibody after fixation with glutaraldehyde. These data suggest that the observed immunoreaction is directed against an epitope apparently created by crosslinking of enamel proteins during fixation. Although the labeling cannot be considered specific, it is nevertheless selective because it is very precisely localized over compartments containing enamel proteins and shows no binding to other calcified dental tissues, including dentin and bone. The V9-S antibody can therefore be used as a reliable probe to identify the presence and distribution of amelogenins in fixed tissues. (J Histochem Cytochem 47:1237-1245, 1999)