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CEOT Variants or Entities: Time for a Rethink? A Case Series with Review of the Literature. Head Neck Pathol 2020; 15:186-201. [PMID: 32642935 PMCID: PMC8010033 DOI: 10.1007/s12105-020-01200-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 07/01/2020] [Indexed: 10/27/2022]
Abstract
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.
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Flores IL, Schneider TRR, Vasconcelos ACU, Tarquinio SBC, Alves de Mesquita R, Gomes APN. Is Conservative Surgery the Best Approach for Peripheral Calcifying Epithelial Odontogenic Tumors? Open Dent J 2018; 12:856-863. [PMID: 30505366 PMCID: PMC6210496 DOI: 10.2174/1874210601812010856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 09/16/2018] [Accepted: 10/05/2018] [Indexed: 11/22/2022] Open
Abstract
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%.
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Affiliation(s)
- Isadora Luana Flores
- Department of Conservative Dentistry, Oral Pathology, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos 2492, Santa Cecília, Porto Alegre, RS, Brazil
| | - Tissiana Rachel Rossi Schneider
- Pelotas Dental School, Semiology and Clinic, Federal University of Pelotas, Rua Gonçalves Chaves, 457, Bairro Centro, Pelotas, RS, Brazil
| | - Ana Carolina Uchoa Vasconcelos
- Pelotas Dental School, Semiology and Clinic, Federal University of Pelotas, Rua Gonçalves Chaves, 457, Bairro Centro, Pelotas, RS, Brazil
| | - Sandra Beatriz Chaves Tarquinio
- Pelotas Dental School, Semiology and Clinic, Federal University of Pelotas, Rua Gonçalves Chaves, 457, Bairro Centro, Pelotas, RS, Brazil
| | - Ricardo Alves de Mesquita
- Department of Oral Pathology and Surgery, Federal University of Minas Gerais, Belo Horizonte, Rua Prof Moacir Gomes de Freitas, 688, Bairro Pampulha, Belo Horizonte, MG, Brazil
| | - Ana Paula Neutzling Gomes
- Pelotas Dental School, Semiology and Clinic, Federal University of Pelotas, Rua Gonçalves Chaves, 457, Bairro Centro, Pelotas, RS, Brazil
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Kurihara J, Mori S, Oikawa M, Kumamoto H, Takahashi T. Peripheral clear cell variant of calcifying epithelial odontogenic tumor devoid of calcification. J Oral Sci 2018; 60:469-472. [PMID: 29695670 DOI: 10.2334/josnusd.17-0116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
A clear cell variant of calcifying epithelial odontogenic tumor (CCEOT) affecting an extraosseous site is described. A 60-year-old male patient presented with gingival swelling on the lingual side of the anterior mandible. The results of biopsy suggested clear cell odontogenic carcinoma, and marginal resection of the mandible was performed. The resected specimen was composed of eosinophilic and clear cells with deposits of amyloid-like material. The clear cells exhibited granules that were positive for PAS. There was no calcification in the resected lesion. Based on these features, the conclusive diagnosis was peripheral CCEOT without calcification. No signs of recurrence were evident after 3 years of follow-up.
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Affiliation(s)
- Jun Kurihara
- Division of Oral and Maxillofacial Surgery, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry
| | - Shiro Mori
- Division of Oral and Maxillofacial Surgery, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry
| | - Mariko Oikawa
- Division of Oral Pathology, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry
| | - Hiroyuki Kumamoto
- Division of Oral Pathology, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry
| | - Tetsu Takahashi
- Division of Oral and Maxillofacial Surgery, Department of Oral Medicine and Surgery, Tohoku University Graduate School of Dentistry
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Peripheral Clear Cell Variant of Calcifying Epithelial Odontogenic Tumor: Case Report and Review of the Literature. Head Neck Pathol 2016; 10:481-485. [PMID: 27154023 PMCID: PMC5082050 DOI: 10.1007/s12105-016-0726-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 04/28/2016] [Indexed: 10/21/2022]
Abstract
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.
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Urias Barreras CM, Quezada Rivera D, Koutlas IG, Gaitán Cepeda LA. Clear cell cystic variant of calcifying epithelial odontogenic tumor. Head Neck Pathol 2014; 8:229-33. [PMID: 24081908 PMCID: PMC4022929 DOI: 10.1007/s12105-013-0494-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 09/19/2013] [Indexed: 02/08/2023]
Abstract
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.
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Affiliation(s)
- Cynthia M Urias Barreras
- Oral Pathology Laboratory, Research and Graduate Department, Dental School, National Autonomous University of Mexico, Mexico city, Mexico,
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Affiliation(s)
- Alice E Curran
- University of North Carolina School of Dentistry, Department of Diagnostic Sciences, Division of Oral and Maxillofacial Pathology, CB# 7450, Chapel Hill, NC 27599, USA
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Nascimento GJFD, Pereira KMA, Nonaka CFW, Medeiros AMCD, Galvão HC. Calcifying epithelial odontogenic tumor of the maxilla. Braz J Otorhinolaryngol 2009. [PMID: 19649502 PMCID: PMC9446033 DOI: 10.1016/s1808-8694(15)30669-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Rangel ALCA, da Silva AA, Ito FA, Lopes MA, de Almeida OP, Vargas PA. Clear cell variant of calcifying epithelial odontogenic tumor: is it locally aggressive? J Oral Maxillofac Surg 2009; 67:207-11. [PMID: 19070770 DOI: 10.1016/j.joms.2007.11.029] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2007] [Revised: 09/24/2007] [Accepted: 11/20/2007] [Indexed: 11/26/2022]
Affiliation(s)
- Ana Lúcia Carrinho Ayrosa Rangel
- Department of Oral Diagnosis, Oral Pathology, Piracicaba Dental School, State University of Campinas, Piracicaba, São Paulo, Brazil
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Anavi Y, Kaplan I, Citir M, Calderon S. Clear-cell variant of calcifying epithelial odontogenic tumor: clinical and radiographic characteristics. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2003; 95:332-9. [PMID: 12627106 DOI: 10.1067/moe.2003.8] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Clear cells have been reported in approximately 8% of cases of calcifying epithelial odontogenic tumor (CEOT). The purpose of this study was to describe the clinical and radiographic features of clear-cell CEOT (CCEOT). STUDY DESIGN Eighteen cases of CCEOT were identified by review of the literature from 1958 to 2001, and a new one was added (total 19; 12 central, 7 peripheral). RESULTS Fourteen tumors (74%) were located in the mandible, with the central lesions favoring the posterior area and the peripheral lesions the anterior-bicuspid area. Radiographic features were as follows: 50% radiolucent, 50% mixed radiolucent-radiopaque; 92% unilocular; 64% well-defined noncorticated borders, 27% well-defined corticated borders, 9% irregular borders. Cortical perforation was common (67%) compared with CEOT without a clear-cell component (6.7%). Recurrence was reported in 17% of the central lesions and none of the peripheral ones. CONCLUSIONS CCEOT is a distinct variant of CEOT; its high tendency for cortical perforation may indicate a more aggressive behavior.
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Affiliation(s)
- Yakir Anavi
- Department of Oral and Maxillofacial Surgery, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel
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Mesquita RA, Lotufo MA, Sugaya NN, De Araújo NS, De Araújo VC. Peripheral clear cell variant of calcifying epithelial odontogenic tumor: Report of a case and immunohistochemical investigation. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2003; 95:198-204. [PMID: 12582361 DOI: 10.1067/moe.2003.63] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A case of peripheral calcifying epithelial odontogenic tumor, clear cell variant, located on the right gingival maxilla of a 48-year-old woman, presenting as a 2.0-cm solitary, firm nodule was studied. Microscopically, it was composed of polyhedral and clear epithelial cells associated with amyloid-like deposition. The clear epithelial cells exhibited granules that were positive for periodic acid-Schiff, and the amyloid-like deposit stained with Congo red showed a green birefringence in the polarized light. Polyhedral and clear epithelial cells were immunopositive for AE1/AE3 and cytokeratin 14. Immunoexpression of fibronectin and types I and III collagen were different between the amyloid-like deposits and the connective tissue stroma. Tenascin surrounded epithelial cells located inside the amyloid-like deposits. Laminin and type IV collagen were immunodetectable around the strands, cords, and nests of epithelial cells. This report represents the seventh case of peripheral calcifying epithelial odontogenic tumor, clear cell variant.
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Cheng YSL, Wright JM, Walstad WR, Finn MD. Calcifying epithelial odontogenic tumor showing microscopic features of potential malignant behavior. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2002; 93:287-95. [PMID: 11925538 DOI: 10.1067/moe.2002.121991] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Calcifying epithelial odontogenic tumor (CEOT) is a rare benign, but locally aggressive, odontogenic tumor, and only 2 cases of malignant CEOT are reported in the literature. We describe a case of an atypical CEOT that penetrates the blood vessels, invades bone, and perforates the cortical plates of the mandible. On histologic examination, it shows marked pleomorphism and numerous mitotic figures, including a tripolar mitotic figure. Proliferating activity was found to be 5 times higher than typical CEOTs as demonstrated by the proliferating index, Ki-67, and analyzed by a computerized image analysis system. The Ki-67 labeling index of this case was also compared to various previously reported benign and malignant neoplasms. Although there is no clinical finding of metastasis, we believe this neoplasm has malignant potential on the basis of the histologic features of vascular invasion, significant mitotic activity, atypical mitotic figures, and an increased proliferating index.
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Affiliation(s)
- Yi-Shing Lisa Cheng
- Oral and Maxillofacial Pathology, Diagnostic Sciences, Baylor College of Dentistry-Texas A&M University System, Health Science Center, Dallas, TX 75246, USA.
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