Cementoblastoma: An updated analysis of 258 cases reported in the literature

A Rare Case of Cementoblastoma of the Second Right Maxillary Premolar in a 30-Year-Old Man

Cementoblastoma is a benign odontogenic mesenchymal tumor characterized by cementum production. Cementoblastoma is considered a relatively rare neoplasm with a predilection to the posterior region of the mandible. The main clinical differential diagnoses include hypercementosis, cemento-osseous dysplasia, condensing osteitis, idiopathic osteosclerosis, osteoblastoma, odontoma, and osteosarcoma. Imaging findings may be pathognomonic when demonstrative. Although rather identical histologically, cementoblastoma exhibits unequivocal fusion to the root of the tooth, which distinguishes it from osteoblastoma. We present a case of a 30-year-old man with cementoblastoma arising in an unusual location: the root of the second right premolar of the maxilla.

Imaging approach for jaw and maxillofacial bone tumors with updates from the 2022 World Health Organization classification

Jaw and maxillofacial bone lesions encompass a wide variety of both neoplastic and non-neoplastic pathologies. These lesions can arise from various tissues, including bone, cartilage, and soft tissue, each presenting distinct challenges in diagnosis and treatment. While some pathologies exhibit characteristic imaging features that aid in diagnosis, many others are nonspecific. This overlap often necessitates a multimodal imaging approach, combining techniques such as radiographs, computed tomography, and magnetic resonance imaging to achieve a diagnosis or narrow the diagnostic considerations. This article provides a comprehensive review of the imaging approach to jaw and maxillofacial bone tumors, including updates on the 2022 World Health Organization classification of these tumors. The relevant anatomy of the jaw and dental structures that is important for accurate imaging interpretation is discussed.

Giant cementoblastoma involving multiple teeth: A rare case report and review of differential diagnoses

Cementoblastoma, a rare odontogenic benign tumor characterized by calcified cementum-like deposits produced by cementoblasts fused with the tooth root, represents a minute proportion of all odontogenic tumors, with a prevalence ranging from less than 1% to 6.2%. We present a case of a 19-year-old female experiencing pain, progressive swelling, and facial asymmetry in the left lower region over the 1 year ago. Physical examination revealed diffuse swelling in the left mandibular area, demonstrating tenderness and bony hardness on palpation. Radiographic findings displayed a giant, well-defined, relatively round, radiopaque mass, partially delineated by a thin radiolucent halo, and adhered to the roots of the teeth. Computed Tomography imaging revealed an osteoblastic hyperdense mass with extensive buccal and lingual extension. Sagittal images illustrated the mass's continuity with the root apex of the first molar, accompanied by a well-defined hypodense border. A biopsy confirmed the diagnosis of cementoblastoma, leading to the patient undergoing a left hemimandibulectomy. Given the various periapical radiopaque lesions that serve as potential differential diagnoses for cementoblastoma, the ability of the radiologist to distinguish their imaging characteristics plays a crucial role in determining an accurate diagnosis.

Recurrent cementoblastoma with multifocal growth and cellular atypia: a case report

BACKGROUND

Cementoblastoma is a rare odontogenic tumor characterized by the formation of osteocementum-like tissue on a tooth root directly by neoplastic cementoblasts. Although it is categorized as benign, it has a high potential for growth with a certain degree of recurrence risk. However, there are only a few studies describing the features of recurrent cementoblastoma. The diagnosis of recurrent cementoblastoma is challenging not only due to its cytological atypia but also because of its large size and multicentric growth pattern. These characteristics suggest a potential for malignancy.

CASE PRESENTATION

A 29-year-old woman was transferred to our university dental hospital complaining of swelling of the right mandible. She had a history of enucleation of cementoblastoma associated with the third molar of the right mandible. Five years after the initial treatment, imaging demonstrated well-circumscribed multicentric radiopaque lesions in the same area. Histologically, the lesion consisted of osteocementum-like tissue rimmed with polygonal or plump tumor cells. Several cells were large epithelioid cells with bizarre nucleoli, which may be reminiscent of malignant tumors. Otherwise, there were no apparent malignant findings, including proliferative activity or atypical mitotic figure. Besides, tumor cells were positive for c-FOS, a marker of osteoblastoma and cementoblastoma. Eventually, the patient was diagnosed with recurrent cementoblastoma.

CONCLUSIONS

Pathological analyses of this case suggested that the recurrent event in the cementoblastoma altered its growth pattern and tumor cell shape. Moreover, in the case of enucleation surgery, long-term follow-up is important because there is some recurrent risk of cementoblastoma, although it is not high.

Pediatric Gnathic Bony and Mesenchymal Tumors

Evaluation of bone pathology within the head and neck region, particularly the gnathic bonesis is complex, demonstrating unique pathologic processes. In part, this variation is due to odontogenesis and the embryological cells that may be involved, which can contribute to disease development and histologic variability. As with any boney pathosis, the key is to have clinical correlation, particularly with radiographic imaging prior to establishing a definitive diagnosis. This review will cover those entities that have a predilection for the pediatric population, and while it is not all inclusive, it should serve as a foundation for the pathologist who is evaluating bony lesions involving the craniofacial skeleton.

Computer-guided buccal cortical plate separation for removal of calcified benign odontogenic tumors affecting the mandibular angle region

PURPOSE

Surgical removal of intra-bony calcific benign lesions is technically challenging regarding its accessibility, proximity to vital structures, and deteriorating effect on the remaining bony structures.

METHODS

Computer-guided buccal cortical plate separation was performed for ten patients using patient-specific osteotomy locating guides and pre-bent plates. The guide was designed to outline the osteotomy, the buccal cortical plate was separated, the lesion was removed, and finally, the pre-bent plates were used to fix the separated cortex.

RESULTS

Surgical procedures were uneventful for all patients, operation time was 39.5 ± 13.01 min, postoperative pain decreased within the follow-up time intervals, and there was a statistical significant difference between the time intervals (P value < 0.001). Edema and trismus were acceptable. One case showed nerve affection which resolved after 4 weeks.

CONCLUSION

Computer-guided buccal cortical plate separation for removal of intra-bony calcified benign lesions provides a promising approach, especially for inexperienced surgeons.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05329974 . Registered on 6 April 2022-retrospectively registered.

Recurrent benign cementoblastoma: A case report and literature review

A 16-year-old male presented with pain in the right posterior mandible on chewing that had lasted for several months. The radiographic features of the lesion included a radiolucent-radiopaque mixed-density mass with a radiolucent rim attached to the root of the mandibular right first molar. The preliminary radiographic diagnosis was benign cementoblastoma, which was confirmed by histopathological examination following surgical excision. The lesion recurred 3 years after treatment; radiographically, it consisted of 3 round foci with mixed radiopacity, each with a radiolucent rim near the root of the mandibular right second premolar and the edentulous postoperative region. The lesion was diagnosed as recurrent benign cementoblastoma and a second surgery was scheduled. This report presented an unusual case of recurrent benign cementoblastoma following surgical excision and extraction of the involved tooth, along with a literature review on reported cases of recurrent benign cementoblastoma with a focus on its clinical features and the best treatment options.

Concomitant bilateral mandibular cemento-ossifying fibroma and cementoblastoma: case report of an extremely rare occurrence

BACKGROUND

Cemento-ossifying fibroma (COF) and cementoblastoma (CB) are rare benign odontogenic tumors with a predilection for the mandible. Cemento-ossifying fibroma is a fibro-osseous lesion that originates in the tooth bearing areas of jaw and shows cementum-like tissue in a fibrotic stroma. Cementoblastoma is classically related to roots of teeth with the presence of calcified cementum-like material. To date, only a single case of concomitant unilateral COF and CB has been reported in the literature.

CASE PRESENTATION

We present an unusual case of a 37-year-old female who presented with two discrete bilateral swellings in the right and left mandible for 10 years. The larger tumor involved the left posterior mandible with extension anteriorly to the left and right anterior mandibles, and the smaller tumor was present in right posterior mandible. Radiology revealed two distinct lesions involving both sides of mandible. Histopathological examination showed characteristic features of cemento-ossifying fibroma in sections of the larger tumor and cementoblastoma in sections of smaller tumor.

CONCLUSION

This case shows the very unique bilateral co-existence of COF and CB, the second case reported in literature to date.

Practical Approach to Radiopaque Jaw Lesions

Radiopaque lesions of the jaw are myriad in type and occasionally protean in appearance. In turn, the radiologic analysis of these lesions requires a systematic approach and a broad consideration of clinical and imaging characteristics to enable reliable radiologic diagnosis. Initially categorizing lesions by attenuation pattern provides a practical framework for organizing radiopaque jaw lesions that also reflects important tissue characteristics. Specifically, the appearance of radiopaque lesions can be described as (a) densely sclerotic, (b) ground glass, or (c) mixed lytic-sclerotic, with each category representing a distinct although occasionally overlapping differential diagnosis. After characterizing attenuation pattern, the appreciation of other radiologic features, such as margin characteristics or relationship to teeth, as well as clinical features including demographics and symptoms, can aid in further narrowing the differential diagnosis and lend confidence to clinical decision making. The authors review the potential causes of a radiopaque jaw lesion, including pertinent clinical and radiologic features, and outline a simplified approach to its radiologic diagnosis, with a focus on cross-sectional CT. An invited commentary by Buch is available online. ^©RSNA, 2021.

FOS Rearrangement and Expression in Cementoblastoma

Cementoblastomas are rare odontogenic tumors developing in close proximity to the roots of teeth. Due to their striking morphologic resemblance to osteoblastomas of the peripheral skeleton, we set out to determine whether cementoblastomas harbor the same FOS rearrangements with overexpression of c-FOS as has recently been described for osteoblastomas. In total, 16 cementoblastomas were analyzed for FOS expression by immunohistochemistry and for FOS rearrangements by fluorescence in situ hybridization (FISH). We observed strong and diffuse staining of c-FOS in 71% of cementoblastomas and identified a FOS rearrangement in all cases (n=3) applicable for FISH. In the remaining cases, FISH failed due to decalcification. Cementoblastomas harbor similar FOS rearrangements and show overexpression of c-FOS like osteoblastomas, suggesting that both entities might represent parts of the spectrum of the same disease.

Desmoplastic ameloblastoma: a systematic review of the cases reported in the literature

The aim of this study was to integrate the available data published on desmoplastic ameloblastoma (DA) into a comprehensive analysis of its clinical/radiographic features. As it is not clear whether the hybrid ameloblastoma has a unique biological behaviour, the clinical/radiographic features of conventional DA were compared with those of the hybrid variant. An electronic search was undertaken in May 2019. Eligibility criteria included publications with sufficient clinical/radiographic/histological information to confirm the diagnosis. A total of 128 publications reporting 285 DAs were included (246 central non-hybrid, 33 central hybrid, 6 peripheral). There was a statistically significant difference between non-hybrid and hybrid cases concerning lesion location, radiographic limits, and size. In contrast to non-hybrid tumours, which showed a similar distribution in the mandible and maxilla, hybrid tumours showed a high predominance of mandible location. Non-hybrid lesions more often showed ill-defined radiographic margins, and were smaller tumours than hybrid DAs. Enucleation with an additional therapy (either curettage or peripheral osteotomy) or resection led to a lower recurrence risk in comparison to curettage or enucleation without additional therapy. The location of the lesion and type of treatment are related to tumour recurrence. There are important differences in location and radiographic limits between hybrid and non-hybrid DAs, which support their classification as distinct lesions.

Juvenile ossifying fibroma of the jaws and paranasal sinuses: a systematic review of the cases reported in the literature

The aim was to compare clinical and radiological features of the two juvenile ossifying fibroma (JOF) variants, trabecular (JTOF) and juvenile psammomatoid ossifying fibroma (JPOF). An electronic search was undertaken in March 2019. Eligibility criteria included publications having sufficient clinical, radiological, and histological information to confirm the diagnosis. A total of 185 publications and 491 cases were included. Most JOFs, including both variants, showed bone expansion, were painless, presented no cortical perforation and no secondary aneurysmal bone cyst, did not cause tooth root resorption, and had a mixed unilocular radiodensity appearance and well-defined limits on radiological examination. Patients with JPOF were on average older than those with JTOF. Enucleation and curettage was associated with a considerably high recurrence rate, regardless of the anatomical location or variant type of the lesion. Enucleation followed by either curettage or peripheral osteotomy showed lower recurrence rates than enucleation only. When resection was performed, only one case of JTOF presented recurrence. In conclusion, JOF lesions presented high rates of recurrence after treatment by curettage and enucleation only. Although surgical resection of JOFs resulted in the virtual absence of recurrence, enucleation followed by peripheral osteotomy/curettage should be the treatment of choice for both JOF variants to avoid the disfigurement usually associated with surgical resection.

Peripheral giant cell granuloma associated with dental implants: a systematic review

The purpose of the present review was to integrate the available published data on peripheral giant cell granuloma (PGCG) associated with dental implants into a comprehensive analysis of its clinical/radiologic features. An electronic search was undertaken in February/2018 in three databases, looking for publications reporting cases of PGCGs associated with dental implants. Nineteen publications were included, reporting 37 implant-associated PGCG. These lesions are more prevalent in women, in mandible, and in posterior regions of the jaws. Both 'excision alone' and 'excision + curettage' presented high recurrence rates (40% and 31.3%, respectively). The etiology of implant-associated PGCG has not yet been determined. Despite the small number of cases reported, implant-associated PGCG shows a high recurrence rate (1/3) for a benign non-neoplastic lesion and sometimes it requires the removal of the associated implant in order to prevent further recurrences. This recurrence rate is not affected by curettage after excision.

Gorham-Stout disease with involvement of the jaws: a systematic review

The purpose of this study was to systematically review all published cases of Gorham-Stout disease (GSD) involving the jaws and to identify the clinico-radiological and histopathological features associated with persistence of the lesions, as well as the best treatment options available. An electronic search was undertaken in November 2018. Eligibility criteria included publications with sufficient information to confirm the diagnosis. Eighty-six publications reporting 89 cases were included. Features observed included symptomatic disease (51.1%), swelling (34.1%), pathological fracture (31.8%), history of previous trauma (32.1%), high alkaline phosphatase levels (24.3%), and predominance of vascular tissue (72.4%). Nearly a quarter of the patients were only followed up, with no treatment implemented. Most treatments consisted of some type of surgery with/without additional therapies (42.0%), drugs (20.5%), and radiotherapy (14.8%). Half of the cases were found to persist after some treatment modality, and five patients died. Among the variables investigated, only a lesion crossing the midline showed an association with persistence of the disease. There remains much to understand about GSD, a rare condition with no clear consensus on the aetiopathology, an unpredictable clinical course, and no standard treatment. The high rate of persistence after treatment was found to be associated only with the lesion crossing the midline.

Idiopathic bone cavity of the jaws: an updated analysis of the cases reported in the literature

The aim of this systematic review was to compare the clinical and radiological features of solitary and multiple idiopathic bone cavities (IBCs) reported in the jaws, as well as to identify possible features that may have some influence on the frequency of persistence of IBC following treatment. An electronic search was undertaken in August 2018. Eligibility criteria included publications with sufficient clinical, radiological, and histological information to confirm the diagnosis. A total of 284 publications reporting 1253 IBCs were included. Multiple IBCs affected older patients and female patients more frequently in comparison to solitary IBCs. While trauma was more commonly found in cases of solitary IBC, scalloping around teeth, bone expansion, and persistence of the cavity following treatment were more significantly associated with multiple lesions. The most relevant factors that are suggested to influence the persistence of the cavity are 'surgical access only' in comparison to 'curettage', presence of scalloping around teeth, patients with multiple IBCs, and a larger lesion size. Solitary and multiple IBCs differ in some clinical and radiological aspects and show distinct rates of persistence following treatment. Curettage is the treatment of choice for IBCs compared to surgical access only.

Benign cementoblastoma involving left deciduous first molar: A case report and review of literature

Cementoblastoma, a benign mesenchymal odontogenic neoplasm is derived from ectomesenchymal cells of the periodontium. Cementoblastomas associated with primary teeth are extremely rare as permanent mandibular first molars are mostly affected. Only 17 cases of those associated with deciduous dentition have been reported so far. The present case report describes a true cementoblastoma of an 8-year-old male child in relation to the left first primary mandibular molar along with emphasis on differential diagnosis.

Melanotic neuroectodermal tumour of infancy of the jaws: an analysis of diagnostic features and treatment

The purpose of this study was to integrate the available published data on melanotic neuroectodermal tumour of infancy (MNTI) of the jaws into a comprehensive analysis of its clinical/radiological features, with emphasis on the predictive factors associated with recurrence. Eligibility criteria included publications with sufficient clinical/radiological/histological information to confirm the diagnosis. A total of 288 publications reporting 429 MNTI cases were included. MNTIs were slightly more prevalent in males and markedly more prevalent in the maxilla. Most of the lesions were asymptomatic, presenting cortical bone perforation and tooth displacement. Nine lesions were malignant, with metastasis in five cases. Enucleation was the predominant treatment (67.2%), followed by marginal (18.4%) and segmental resection (6.1%). Eighty-one of 356 lesions (22.8%) recurred. Recurrence rates were 61.5% for curettage, 25.3% for enucleation alone, 16.2% for enucleation+curettage, 20.0% for enucleation+peripheral osteotomy, 11.3% for marginal resection, 10.0% for segmental resection, 30.0% for chemotherapy, and 33.3% for radiotherapy. Enucleation and resection presented significantly lower recurrence rates in comparison to curettage. Curettage appears not to be the best form of treatment, due to its high recurrence rate. As resection (either marginal or segmental) is associated with higher morbidity, enucleation with or without complementary treatment (curettage or peripheral osteotomy) would appear to be the most indicated therapy.

Central giant cell lesion of the jaws: An updated analysis of 2270 cases reported in the literature

PURPOSE

To review all available data published on central giant cell lesion (CGCL) of the jaws into a comprehensive analysis of its clinical/radiological features, with emphasis on the predictive factors associated with its recurrence.

METHODS

An electronic search was undertaken in 5 databases (February/2018), looking for reporting cases of CGCLs.

RESULTS

A total of 365 publications were included, comprising 2270 lesions. CGCLs were more prevalent in women and the mandible. Cortical bone perforation occurred in 50% of the cases. Marginal/segmental resection was more often performed in larger lesions, and drug therapy was more frequent in small lesions. Recurrence was reported in 232 of 1316 cases (17.6%). The recurrence rate of the aggressive lesions (22.8%) after surgical treatment was higher than non-aggressive lesions (7.8%). Four of 5 CGCLs showed partial/total regression with pharmacological treatment. Aggressive lesions showed a worse response to corticosteroids than non-aggressive lesions. For the lesions submitted to surgery as the first treatment, curettage, enucleation, or marginal resection in relation to segmental resection, aggressive lesions, cortical bone perforation, and tooth root resorption were associated with increased recurrence rate. Recurrence related to a combination of surgical/pharmacological treatment could not be evaluated due to the variety of protocols.

CONCLUSIONS

Aggressive CGCLs recur more often than the non-aggressive ones. Despite sometimes showing poor response to corticosteroid injection or surgical curettage, a combination of both treatment strategies should be considered in aggressive cases to reduce morbidities associated with radical surgery. The best protocol to manage aggressive and non-aggressive lesions remains to be determined.

Squamous odontogenic tumor and squamous odontogenic tumor-like proliferations in odontogenic cysts: An updated analysis of 170 cases reported in the literature

PURPOSE

To integrate the available data published on squamous odontogenic tumors (SOT) and squamous odontogenic tumor-like proliferations in odontogenic cysts (SOT-LPOC) into a comprehensive analysis of their clinical/radiologic features.

MATERIALS AND METHODS

An electronic search was undertaken in January 2017. Eligibility criteria included publications having enough clinical/radiological/histological information to confirm a definite diagnosis.

RESULTS

A total of 74 publications reporting 110 SOTs (102 central, 8 peripheral) and 60 SOT-LPOC were included. Compared to SOT-LPOC, SOT showed lower mean age, no preference regarding maxilla or mandible localization, significant association with cortical bone perforation, multilocular radiographic appearance, and mobility of the tooth/teeth associated with the lesion. While 5 recurrent SOT were reported after enucleation, no recurrent SOT-LPOC was found.

CONCLUSIONS

SOT shows a more aggressive biologic behavior than SOT-LPOC, which supports the hypothesis that the two lesions are distinct clinicopathological conditions.