Adenomatoid odontogenic tumor mimicking a globulo-maxillary cyst

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Adenomatoider odontogener Tumor in kalzifizierender odontogener Zyste

BACKGROUND

Adenomatoid odontogenic tumors (AOT) and calcifying odontogenic cysts (COC, Gorlin's cyst) are rare benign specificities of odontogenic tumors. Most odontogenic tumors are lesions of embryonic odontogenic tissue. Radiographically, odontogenic tumors may mimic an odontogenic follicular cyst.

CASE REPORT

This paper describes the case of an 11-year-old female patient with a remarkable combination of these two entities. The lesions were found at the site of a retained first premolar and a persistent deciduous tooth 84 of the right lower jaw. Without clinical symptoms the tumor had expanded the vestibular cortical bone of the premolar region. Radiographically, the lesion appeared as a typical follicular cyst. During the operation, excochleation of the cyst was performed and the premolar was extracted. Finally, the epithelium of the cyst was treated by curettage. The histologic specimen revealed the diagnosis of an adenomatoid odontogenic tumor (AOT) in a calcifying odontogenic cyst (COC).

DISCUSSION

The described case shows that symptoms of odontogenic tumors are usually nonspecific. For that reason one should always take a biopsy for histological investigation when patients present atypical cysts of the jaw. In rare cases even malignant odontogenic neoplasms could occur.

Adenomatoid odontogenic tumor presenting as periapical disease

Adenomatoid odontogenic tumor commonly occurs in association with the crowns of unerupted teeth. An extrafollicular variant, radiographically in relationship to root apices, has been reported. However, clear association with the root apices at surgery has not been demonstrated. We report a case of adenomatoid odontogenic tumor in the anterior mandible in a 21-year-old woman that presented radiographically at the root apices and at surgery as a radicular cyst. We believe this represents the first reported case of adenomatoid odontogenic tumor presenting as periapical disease both clinically and radiographically. The diagnosis of adenomatoid odontogenic tumor should be considered when the clinician is presented with a corticated radiolucency in the anterior jaw, especially in teens and young adults.

Adenomatoid odontogenic tumour in a 12-year-old boy

We present a rare finding of adenomatoid odontogenic tumour (AOT) in a 12-year-old boy who was referred to the Department of Paediatric Dentistry at the Eastman Dental Hospital for the extraction of a carious maxillary permanent molar. First presentation revealed that the maxillary right permanent lateral incisor and canine were unerupted. Radiological examination revealed a circumscribed radiolucent area associated with the distal aspect of the maxillary right permanent lateral incisor. The patient was admitted to our Day Care Unit where the carious maxillary molar was extracted and the radiolucent area associated with the maxillary right permanent incisor was explored. Pathological examination confirmed the lesion as adenomatoid odontogenic tumour. We present a brief review of the literature and consider how differential diagnosis of this tumour from more common odontogenic lesions can be established.

Adenomatoid odontogenic tumour. Report of an unusual lesion in the posterior maxilla

The adenomatoid odontogenic tumour most commonly presents as a 1.5-3 cm radiolucency in the anterior maxilla, and often associated with an unerupted tooth. It is very unusual for these tumours to occur behind the premolar region and the few reports of much bigger lesions have been in black African patients. This article describes an unusually large example of this tumour associated with an unerupted maxillary third molar tooth in a white female.

Adenomatoid odontogenic tumour: a report of two large lesions

Adenomatoid odontogenic tumours with a diameter of more than 4 cm are uncommon. Two cases, both measuring in excess of 7 cm, are described and the differential diagnosis discussed. The progressive growth and cortical perforation in these two cases support the view that it is a benign neoplasm rather than a hamartoma.

Adenomatoid odontogenic tumour: co-expression of keratin and vimentin

Immunohistochemical observations of intermediate sized proteins in five cases of adenomatoid odontogenic tumour (AOT) are described. The immunohistochemical detections of keratins were made with polyclonal antiserum (TK, 41-65 kDa) and three monoclonal keratin antibodies (KL1: 55-57 kDa; PKK1: 40, 45, and 52.5 kDa and nos. 19, 18, 8; K8.12: nos. 16, 13) and vimentin and desmin monoclonal antibodies. Histologically, the tumour epithelia could be divided into two types: type A cells were a spindle or columnar shape and formed solid, ductal, tubular or whorled structures. Type B cells were small and compact cells at the periphery of the A cell-containing focus. Immunohistochemically, the type A cells showed very slight reaction with all antibodies to keratins, whereas the type B cells indicated slight-to-moderate expression of keratin and vimentin, and showed coexpression. Both types of cell showed a negative reaction for desmin. Only one case was associated with cystic lesions, and the cyst-lining was composed of thin squamous epithelium. Keratin expression in this epithelium was strong. In the histogenesis of AOT it was postulated that the tumour cells may have originated from undifferentiated odontogenic epithelium or stratum intermedium cells.