Non-calcifying and Langerhans cell-rich variant of calcifying epithelial odontogenic tumor

Non-Calcifying/Langerhans Cell-Rich Calcifying Epithelial Odontogenic Tumour: A Critical Review of the Rare and Distinctive Entity

BACKGROUND

The study aims to analyse the non-calcifying/Langerhans cell rich (NCLC) subtype of calcifying epithelial odontogenic tumour (CEOT).  METHOD: The features of cases of the NCLC subtype of CEOT noted in the English literature by PubMed as well as 3 new cases were reviewed.

RESULTS

Overall, twenty-one cases were noted. Many were women in the fourth to sixth decades (male-to-female ratio =1 to 2). Radiologically, the lesion is often unilocular with resorption of the affected teeth. Nineteen of the 21 cases occurred in the maxilla, especially the anterior portion. On pathological examination, epithelial cells are noted in non-calcifying amyloid-rich fibrous stroma. The main differential diagnosis is the amyloid subtype of central odontogenic fibroma. Immunohistochemical studies revealed the tumour epithelial cells were positive for cytokeratins and p63 and contained CD1a, S-100, and langerin-positive Langerhans cells. On a median follow-up of 2 years, one patient had a recurrence one year after curettage.

CONCLUSION

The NCLC subtype of CEOT is unique as it contains significant numbers of Langerhans cells and has clinicopathological features distinctive from classic CEOT.

Non-calcifying Langerhans Cell Rich Variant of Calcifying Epithelial Odontogenic Tumor and Amyloid Rich Variant of Central Odontogenic Fibroma: A Unique Entity or a Spectrum?

Overlapping clinicopathological features of non-calcifying Langerhans cell rich variant of calcifying epithelial odontogenic tumor (NCLC-CEOT) and the amyloid rich variant of the central odontogenic fibroma (AR-COF) have been recognized recently. It is still under debate whether these two diseases are indeed one unique disease entity or belong to CEOT and COF, respectively. To clarify this issue, we have performed a literature review to compare the similarities and differences in clinicopathological features among NCLC-CEOT, AR-COF, classic CEOT, and classic COF. We aimed to investigate whether NCLC-CEOT and AR-COF might be the same and one distinctive disease entity, or a variant (or variants) of either CEOT or COF; or whether COF, NCLC-CEOT/AR-COF, and CEOT represented a histopathological spectrum of one disease. Our results indicate that NCLC-CEOT and AR-COF cases share many similar clinicopathological features. Thus, we suggest that they are the same disease entity. Due to nearly no reported recurrence of NCLC-CEOT/AR-COF cases, the conservative surgical treatment is appropriate. The NCLC-CEOT/AR-COF cases show some overlapping clinicopathological features with COF rather than the CEOT cases. However, differences in the clinicopathological features are still recognized among the NCLC-CEOT/AR-COF, COF, and CEOT cases. Future research, particularly molecular biological studies, may further elucidate their relationships and assist proper classification of the NCLC-CEOT/AR-COF cases.

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

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

Calcifying epithelial odontogenic tumor: a case series spanning 25 years and review of the literature

OBJECTIVE

The calcifying epithelial odontogenic tumor (CEOT) is a rare benign neoplasm that makes up less than 1% of all odontogenic tumors. This study aims to describe a case series of CEOT spanning 25 years and to review and compare our results with the existing literature.

STUDY DESIGN

With institutional review board approval, all CEOT archival cases from the University of Florida Oral Pathology Biopsy Service between 1994 and 2019 were retrieved. A total of 20 cases were included. Based on current criteria, 2 cases that stained positively for CD1 a were excluded, because these most likely represented the amyloid-rich variant of central odontogenic fibroma.

RESULTS

Average patient age was 40 years. Females and males were affected equally (n = 10). The mandible was more commonly involved (60%, n = 12) than the maxilla (40%, n = 8). CEOT variants included incipient CEOT (10%, n = 2) and peripheral CEOT (10%, n = 2). One case exhibited features of adenomatoid odontogenic tumor in addition to CEOT. Congo red staining for amyloid was performed in 13 cases, all of which were positive.

CONCLUSION

Our results align with the literature. Awareness of the different variants of CEOT and of the separate but similar-appearing amyloid-rich variant of central odontogenic fibroma will help to ensure accurate diagnosis and appropriate treatment.

Stafne bone defect of the molar region of the mandible

Background/purpose

The classic Stafne bone defect (SBD) is a rare small well-demarcated radiolucent lesion in the molar region of the mandible near the mandibular angle. This study reported a series of 5 SBD cases.

Materials and methods

This study reviewed 4000 consecutive panoramic radiographs from February 2017 to May 2017 and found 5 classic SBD cases. The clinical and radiographic findings of these 5 SBD cases were reported.

Results

We found 5 SBD cases presenting as small, well-defined, and radiolucent lesions at the typical first molar to third molar region of the mandible near the mandibular angle and below the mandibular canal. The mean age of the 5 patients at the time of diagnosis was 53.4 years (range, 45-69 years). All the 5 SBD cases occurred in male patients, 3 were on the right side and 2 were on the left side of the mandible. The mean greatest dimension of the 5 SBDs was 1.5 cm (range, 1.2-1.9 cm). All the 5 SBD cases were found incidentally on the panoramic radiographs and two of them were confirmed by cone-beam computed tomography. No surgical intervention was performed for these 5 SBD cases.

Conclusion

The classic SBDs occur most frequently in male patients in the age group between 40 years and 60 years. For the SBDs at the typical site of the molar region of the mandible near the mandibular angle and below the mandibular canal, these lesions can be monitored by panoramic radiography once per one or two years.

Non-calcifying Langerhans Cell-Rich Variant of Calcifying Epithelial Odontogenic Tumor: A Distinct Entity with Predilection for Anterior Maxilla

Calcifying epithelial odontogenic tumor (CEOT) is an uncommon locally invasive epithelial odontogenic tumor of the jaws associated with amyloid production. Intraosseous presentations are most common and they frequently occur in the posterior mandible. A non-calcifying Langerhans cell-rich variant of CEOT (NCLC CEOT) has been described with predilection for the anterior maxilla. Interestingly, all reported cases of NCLC CEOT have occurred in Asian population. We present a case of a 43-year old Caucasian female with a large radiolucent lesion involving the left anterior maxilla with histologic features of NCLC CEOT. This is the first reported case of this rare variant of CEOT in a Caucasian individual.

S100 protein-positive Langerhans cells in 80 dentigerous cysts

BACKGROUND/PURPOSE

Langerhans cells (LCs) are antigen-presenting cells. This study assessed the LC counts in 80 dentigerous cysts (DCs).

MATERIALS AND METHODS

The S100-positive LC numbers in the lining epithelia and subepithelial connective tissues were counted at 80 DC sites without inflammation, 33 DC sites with mild/moderate inflammation, and 9 DC sites with severe inflammation from 80 DC specimens.

RESULTS

The mean S100-positive LC counts in the lining epithelia and subepithelial connective tissues increased significantly from no inflammation (0.6 ± 0.6 and 0.7 ± 0.6 cell/high-power field or HPF, respectively) through mild/moderate inflammation (8.1 ± 2.0 and 4.5 ± 2.3 cells/HPF, respectively) to severe inflammation DC sites (21.0 ± 7.0 and 11.1 ± 6.5 cells/HPF, respectively; P-value < 0.001). DC sites with inflammation had thicker lining epithelia than those without inflammation. Moreover, the mean LC counts in the lining epithelia and subepithelial connective tissues of DCs were significantly higher in the thicker lining epithelium (>50 μm) group (8.6 ± 7.1 and 4.8 ± 4.5 cells/HPF, respectively) than in the thinner lining epithelium (≦50 μm) group (0.6 ± 0.6 and 0.6 ± 0.6 cells/HPF, respectively; both P-values < 0.001).

CONCLUSION

A significant association of high-grade inflammation and thick lining epithelium with the increased LC number in DCs is found. Very few LCs in the lining epithelia of DCs without inflammation indicate the reduced immunosurveillance ability against DC lining epithelial cells in DC patients. It needs further studies to confirm the role of reduced immunosurveillance in the enlargement of the DC.

Langerhans cells in 60 odontogenic keratocysts

BACKGROUND/PURPOSE

Langerhans cells (LCs) are antigen-presenting cells. This study mainly evaluated the LC counts in 60 odontogenic keratocysts (OKCs).

MATERIALS AND METHODS

The CD1a-positive LC numbers in the lining epithelia and subepithelial connective tissues were counted at 60 OKC sites without inflammation, 39 OKC sites with mild/moderate inflammation, and 13 OKC sites with severe inflammation from 60 OKC specimens.

RESULTS

The mean CD1a-positive LC counts in the lining epithelia and subepithelial connective tissues increased significantly from no inflammation (0.5 ± 0.4 and 0.2 ± 0.3 cell/high-power field or HPF, respectively) through mild/moderate inflammation (5.3 ± 2.5 and 2.5 ± 2.7 cells/HPF, respectively) to severe inflammation OKC sites (12.7 ± 5.6 and 9.3 ± 7.2 cells/HPF, respectively; all P-values < 0.001). OKC sites with inflammation had thicker lining epithelia than those without inflammation. Moreover, the mean CD1a-positive LC counts in the lining epithelia and subepithelial connective tissues of OKCs were significantly higher in the thicker lining epithelium (>100 μm) group (6.8 ± 5.1 and 3.7 ± 4.9 cells/HPF, respectively) than in the thinner lining epithelium (≦100 μm) group (1.0 ± 1.7 and 0.8 ± 2.5 cell/HPF, respectively; both P-values < 0.001).

CONCLUSION

There is a significant association of inflammation grade with the number of LCs in OKCs. The scarce LCs in the lining epithelia of OKCs without inflammation suggests the loss of immunosurveillance ability against the OKC lining epithelial cells; this can explain why OKCs have aggressive clinical behavior, a great growth potential, and a high recurrence rate.

Significant association of inflammation grade with the number of Langerhans cells in odontogenic keratocysts

BACKGROUND/PURPOSE

Langerhans cells (LCs) are antigen-presenting cells. This study assessed the LC counts in odontogenic keratocysts (OKCs).

METHODS

The LC numbers in the lining epithelia and subepithelial connective tissues were counted at 60 OKC sites without inflammation, 39 OKC sites with mild/moderate inflammation, and 13 OKC sites with severe inflammation from 60 OKC specimens immunostained with anti-S100 antibodies.

RESULTS

The mean LC counts in the lining epithelia and subepithelial connective tissues increased significantly from no inflammation (0.5 ± 0.4 and 0.7 ± 0.6 cell/high-power field or HPF, respectively) through mild/moderate inflammation (5.9 ± 2.7 and 5.0 ± 3.5 cells/HPF, respectively) to severe inflammation OKC sites (14.7 ± 5.3 and 13.3 ± 6.8 cells/HPF, respectively; all P-values < 0.001). OKC sites with inflammation had thicker lining epithelia than those without inflammation. Moreover, the mean LC counts in the lining epithelia and subepithelial connective tissues of OKCs were significantly higher in the thicker lining epithelium (>100 μm) group (7.7 ± 5.6 and 6.5 ± 5.8 cells/HPF, respectively) than in the thinner lining epithelium (≦ 100 μm) group (1.0 ± 2.0 and 1.4 ± 2.6 cells/HPF, respectively; both P-values < 0.001).

CONCLUSION

A significant association of inflammation grade with the number of LCs in OKCs is found. The paucity of finding LCs in the lining epithelia of OKCs without inflammation indicates the loss of immunosurveillance ability against the OKC lining epithelial cells; this can explain why OKCs have aggressive clinical behavior, a great growth potential, and a high recurrence rate.

Langerhans cell counts in oral epithelial dysplasia and their correlation to clinicopathological parameters

BACKGROUND/PURPOSE

Langerhans cells (LCs) are antigen presenting cells. This study assessed the LC counts in oral epithelial dysplasia (OED) and their correlation to clinicopathological parameters.

METHODS

This study examined the LC counts in the epithelia and subepithelial connective tissues of 58 patients with OED (21 mild, 18 moderate, and 19 severe OED lesions) and 10 specimens of normal oral mucosa (NOM) by anti-S-100 protein immunostaining.

RESULTS

We found that the mean LC counts in the epithelia or subepithelial connective tissues increased significantly from NOM samples through mild and moderate OED to severe OED samples. In addition, a significant correlation was found between higher mean LC counts in the dysplastic epithelia of OED samples and OED lesions with thicker epithelial layers (p<0.001) or wider inflammatory zones (p<0.001), and between higher mean LC counts in the subepithelial connective tissues of OED samples and OED lesions with wider inflammatory zones (p<0.001). Moreover, the nine OED lesions with malignant transformation had a significantly lower mean LC count than the 49 OED lesions without malignant transformation.

CONCLUSION

The significant and gradual elevation in LC count from NOM through mild and moderate OED to severe OED lesions suggests an upregulation of immunosurveillance ability in OED patients during the early oral carcinogenesis process. A low LC count in OED lesions may suggest the partial loss of immunosurveillance ability against dysplastic cells; this in turn favors the malignant transformation of an OED lesion into oral cancer.