Adenomatoid odontogenic tumor associated with an unerupted mandibular lateral incisor: a case report

Conservative enucleation for physiologic space closure in adenomatoid odontogenic tumor

Adenomatoid odontogenic tumor (AOT) is a rare, asymptomatic, slow-growing benign tumor that can be divided into three variants: follicular, extrafollicular, and peripheral. By treating AOT using an enucleation and curettage approach, recurrence can be avoided. We report a case of a 24-year-old female who presented with a lump in the right mandibular premolar area along with diastema between displaced teeth #43 and #44 and was diagnosed with extrafollicular AOT. The patient was managed with enucleation-curettage surgery without additional bone graft procedure along with routine follow-up. A successful outcome without recurrence was achieved, and diastema closure with repositioning of the displaced teeth did not require orthodontic treatment. AOT should be managed via enucleation and curettage to obtain successful outcomes without recurrence. Spontaneous bone regeneration following enucleation can be achieved without guided bone regeneration. Also, diastema closure and repositioning of displaced teeth can occur without orthodontic interventions through physiologic drift.

Adenomatoid Odontogenic Tumor Mimicking a Dentigerous Cyst in Maxilla

Aim

To present a case of adenomatoid odontogenic tumor (AOT) associated with impacted maxillary lateral incisor in a 12-year-old female that mimicked dentigerous cyst.

Background

Adenomatoid odontogenic tumor (AOT) was first mentioned by Steensland in 1905, which is a rare tumor of odontogenic origin. Dreibladt in 1907 coined the term pseudo ameloblastoma. In 1948, Stafne considered it a distinct pathological entity.

Case description

A 12-year-old female reported to the Department of Oral and Maxillofacial Surgery with the chief complaint of progressive swelling on the left maxillary anterior region for 6 months. The clinical and radiographical findings of the case represented a dentigerous cyst or unicystic ameloblastoma, but the histopathological interpretation was interpreted as AOT.

Conclusion

The AOT is an unusual entity that is commonly misdiagnosed as a dentigerous or odontogenic cyst. Histopathology plays a vital role in diagnosis and further management.

Clinical significance

The interest and relevance of the present case are the difficulties in diagnosing accurately based on the radiograph and histopathology. Both dentigerous cysts and AOT are entirely benign and encapsulated lesions, and enucleation poses no major difficulties. The case report highlights the importance of early diagnosis of neoplasm arising in odontogenic tissues. The fact that in cases of unilocular lesions surrounding the impacted tooth in the anterior maxillary region, AOT should also be considered as a differential diagnosis.

How to cite this article

Pawar SR, Kshirsagar RA, Purkayastha RS, et al. Adenomatoid Odontogenic Tumor Mimicking a Dentigerous Cyst in Maxilla. Int J Clin Pediatr Dent 2022;15(6):770-773.

Peripheral Adenomatoid Odontogenic Tumor - A Rare Cause of Gingival Enlargement: A Case Report with CBCT Findings

Introduction

Adenomatoid odontogenic tumor (AOT) is an uncommon benign odontogenic lesion with varied clinical and histological presentation. It has slow growth potential and a low recurrence rate. The tumor is mainly seen in females in the second decade of life, predominantly affecting the maxilla and associated most often with unerupted canine teeth, earning the epithet “two-thirds tumor”. There are three variants: intrafollicular, extrafollicular, and peripheral. The peripheral or extra osseous type is a rare form that arises in gingival tissue.

Case Presentation

This article describes a case of AOT in a 10-year-old girl who presented with gingival enlargement in relation to the maxillary left central incisor. Interestingly, intraoral periapical radiography did not show any significant findings. However, cone-beam computed tomography of the site revealed significant bone loss in the area. A surgical excision was done. Histopathological examination revealed features of AOT. Based on clinical, radiographic, and histological evidence, a diagnosis of peripheral AOT (PAOT) was made.

Conclusion

PAOT is a rare disease entity in children that mimics gingival swelling, and may often be misdiagnosed by dentists. With literature still ambiguous on the origin of the tumor and biological course, it becomes imperative to examine any gingival swelling in children with a proper clinical examination, periapical radiography, and if necessary cone-beam computed tomography. Excision and histopathological evaluation will help in confirming the exact disease condition.

An Extrafollicular Adenomatoid Odontogenic Tumor Mimicking a Periapical Cyst

Adenomatoid odontogenic tumor (AOT) is a rare noninvasive odontogenic tumor that occurs mostly in the second decade of life. Based on its tooth association, AOT can be classified into three categories of follicular, extrafollicular, and peripheral types; the follicular classification is considered as the most common type of AOT. This study reported a large extrafollicular case of AOT in a 40-year-old female. She was asymptomatic and tumor was detected accidentally by her dental practitioner. Since the panoramic radiograph showed a well-defined unilocular radiolucent lesion, we observed radiopaque spots within the lesion by using cone beam computed tomography. The extrafollicular type can mimic a periapical radiolucent lesion.

Adenomatoid odontogenic tumor: Case series of 14 with wide range of clinical presentation

Background

To present 14 cases of adenomatoid odontogenic tumor (AOT), highlighting their clinical, radiographic, and histologic characteristics.

Material and Methods

Fourteen cases of AOT were retrieved from the archives of the Oral Pathology Biopsy Service (OPBS). Clinical, radiologic, and histologic findings are described.

Results

Fourteen AOT cases were reviewed, of which 12 were intraosseous and two were peripheral (gingiva). The cases came from eight females and six males with an age range of 11–30. Of the 12 intraosseous cases, nine were follicular (associated with impacted teeth), while three were extra-follicular (present between teeth). Six of the 12 cases were in the maxilla, and the other six were in the mandible. The two peripheral cases presented as nodules on the buccal gingiva of the anterior maxillary teeth. Radiographically, all 12 follicular and extra-follicular cases were unilocular radiolucencies; of those, only one had specks of radiopacity. Histologically, all specimens were similar in morphology, demonstrating a varied degree of duct-like structures, epithelial spheres, spindle-shaped epithelial cells, calcifications, and a thick capsule. The two peripheral cases had no capsule.

Conclusions

AOT usually affects patients under 20 years of age, with a female to male ratio close to 2:1. Presentation in the anterior maxilla is almost twice as common as in the anterior mandible. Radiographically, AOT presents as a unilocular radiolucency more commonly associated with impacted teeth, simulating a dentigerous cyst. We present 14 new cases of AOT (nine follicular, three extra-follicular, and two peripheral) with discussions of their clinical, radiographic, and histological features.

Key words:Adenomatoid, odontogenic, tumor.