Article

Relative Frequency of Central Odontogenic Tumors: A Study of 1,088 Cases from Northern California and Comparison to Studies from Other Parts of the World

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Abstract

To determine the relative frequency of central odontogenic tumors in relation to all biopsy specimens and to one another in an oral pathology biopsy service and to compare the data with previous studies from different parts of the world. Files from the Pacific Oral Pathology Laboratory of the University of the Pacific, San Francisco, CA served as a source of material for this study. Files were systematically searched for all cases of central (intraosseous) odontogenic tumors during a 20-year period. Central odontogenic tumors were identified in 1,088 (1.2%) cases out of the 91,178 accessed. Individually, of all odontogenic tumors, 75.9% were odontomas. The prevalence of the remaining tumors appears to be a rare occurrence. The second most common was ameloblastoma (11.7%), followed by odontogenic myxoma (2.2%). Odontomas are considered hamartomas or developmental anomalies. When excluded from the list of individual odontogenic tumors, ameloblastoma is the most common (48.5%), followed by odontogenic myxoma (9.2%), adenomatoid odontogenic tumor (7.3%), ameloblastic fibro-odontoma (7.3%), ameloblastic fibroma (6.5%), calcifying odontogenic cyst (6.5%), and odontogenic fibroma (6.1%). Each remaining tumor comprises less than 4%. Studies related to the relative frequency of individual odontogenic tumors from different parts of the world are difficult to compare because most studies are outdated, the list of tumors is limited, and new entities are not included. To determine the real relative frequency, further studies should be conducted, especially in Western societies, by experienced pathologists in the field of odontogenic tumors.

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... The Para keratinized variant of odontogenic keratocyst is considered one of common changing and update and now viewed as keratocystic odontogenic tumor (KCOT) (4,5) . Many articles and studies collected related to frequency and incidance of OT from different parts of world (6)(7)(8)(9)(10)(11) , but no one of these studies had data on prevalence of OT in Iraq. So the aim of this study was to define the frequency and prevalence of OTs as WHO classification from the histopathological report's archive of oral pathology laboratory in Oral Diagnosis Department/College of Dentistry/Baghdad University were assessed histologic finding of odontogenic tumors for 15-year (1999-2015) and to match these data with studies from further geographical areas of the world. ...
... These varied tumorseven though uncommon but carriage an important therapeutic as well asdiagnostic trial, so awareness offrequency and plain clinical structures have good use in diagnosis and management (10) . So many studies done in different countries shown significant geographic difference in the frequency of OTs (10,11,12,17,18) . In this study the frequency rate was (3.97%) of total oral lesions documented from January 1999 to December 2015, this results similar to study done in Asia (3.9%) (7) , more than middle east (1.9%) (6) , south America was (1.82%) (10,15) , but in north America was (1.55%) and in Iran was (1.9%) (11) . ...
... So many studies done in different countries shown significant geographic difference in the frequency of OTs (10,11,12,17,18) . In this study the frequency rate was (3.97%) of total oral lesions documented from January 1999 to December 2015, this results similar to study done in Asia (3.9%) (7) , more than middle east (1.9%) (6) , south America was (1.82%) (10,15) , but in north America was (1.55%) and in Iran was (1.9%) (11) . but in south Africa was lower than this study (9.6%) (19) , in India was (5.7%) (9) , while in turkey was 7.38% (23) . ...
Article
Background: The purpose of this study was to determine the occurrence of clinically and histopathological diagnosed odontogenic tumors during the period of 15 years in Iraqi population. Materials and Method: A total of 3652 biopsy specimens from the histopathological report’s archive of oral pathology laboratory in Oral Diagnosis Department/College of Dentistry/Baghdad University were assessed histologic finding of odontogenic tumors for 15-year (1999-2015). Clinical data regarding age, gender, and site of lesions were collected from biopsy reports and patient’s files. Results: A total of 145 (3.97%) odontogenic tumors were reported. Ameloblastoma was very mutual odontogenic tumor 49(33.8%), thenkeratocystic odontogenic tumors 29 (20%), peripheral odontogenic fibroma 18 (12.4%), odontogenic myxoma13(9%), and odontoma 11(7.6%), only 5 cases (2.8%) had malignant change, (97.2%) of cases were benign. Odontogenic tumors occurred more in males with most cases appearing in the second and third decades of life. Conclusion: Odontogenic tumorsshown a low incidence among oromaxillofacial lesions and low rate of malignancy changing. Keywords: Odontogenic Tumors; Clinicopathological Evaluation.
... Moreover, the posterior mandible was the most affected site, accounting for 74.3% of the cases. These results conform with other results found in the published literature (18,29). Surprisingly, cemento-ossifying fibroma was the second most prevalent OT in our study accounting for 14.78%. ...
... Odontomas were recorded as the third most common OT in this study with a frequency of 9.13%, similar to what has been found in previous studies (5,9,11). However, studies conducted in Mexico (1), Chile (23) and North California (29) reported higher frequency of odontomas, reporting these lesions as the most prevalent OT in their studies (representing 34.6%, 44.7% and 75.9% respectively). ...
... In particular, odontomas are commonly diagnosed on the basis of clinical and radiographic exams, without histological assessment, resulting in an underestimation of their frequency (12). The mean age of the odontomas was 18.6 years, which agreed with studies that showed that odontoma mostly occurs in younger individuals (29,30). Regarding gender, we observed that odontomas had a female predilection (66.7%), which is different from studies by da-Costa et al. (4), Ahire et al. (16) and Rubini et al. (20), but similar to the studies by Sekerci et al. (5) and Lima-Verde-Osterne et al. (9). ...
Article
Background: Odontogenic tumors (OTs) are considered important among oral lesions because of their clinicopathological heterogeneity and variable biological behavior. The purpose of this retrospective cross-sectional study was to evaluate the frequency and distribution of different types of odontogenic tumors based on the current 2017 WHO Classification of Head and Neck Tumors over a period of 5 years. This was achieved by reviewing the records of Cairo's educational hospitals and institutions and comparing the results with findings in the literature. Material and methods: The records of patients diagnosed with odontogenic tumors were obtained from six educational hospitals and a single institute in Cairo which included: Oral and Maxillofacial Pathology Department, Faculty of Dentistry, Cairo University; General Pathology Department, Faculty of Medicine, Cairo University; Oral Pathology Department, Faculty of Dentistry, Ain Shams University; Eldemerdash Hospital, Ain Shams University; El-Sayed Galal Hospital, Al-Azhar University; Ahmed Maher Teaching Hospital and National Cancer Institute. These records were reviewed over a 5-year (2014-2018) period and the odontogenic tumors were investigated for frequency, age, gender and site. The data were recorded, then analyzed using SPSS software. Results: Intraosseous (central) odontogenic tumors constituted 2.56% of all 8974 registered oral and maxillofacial biopsies. A total of 230 cases of OTs were collected and reviewed. Of these, 97.8% were benign and 2.17% were malignant. The mandible was the most commonly affected anatomic location. Ameloblastoma, with a predilection for the posterior mandible, was the most frequent odontogenic tumor (55.65%), followed by cemento-ossifying fibroma (14.78%) and odontoma (9.13%). Females were more commonly affected than males. Most of the patients were in the third and fourth decades of life. There were no peripheral odontogenic tumors diagnosed in this period. Conclusions: Some similarities and differences between our findings and those of previous studies of various populations were witnessed. OTs may greatly diverge according to the version of the classification used and by the sample size of the study. Retrospective analysis of the relative frequency of OTs in different countries will be helpful in enhancing the understanding of OTs, which is important for both oral maxillofacial surgeons and pathologists.
... In 2017, the new WHO classification of odontogenic tumours reclassified KOT as odontogenic keratocysts, a developmental cyst (6). Although several odontogenic cysts and tumours case series have been reported worldwide, few of them have evaluated and compared both groups of lesions together (7)(8)(9), as well as having information on recurrence (2,(10)(11)(12)(13)(14), and using longitudinal analysis. Our aims were to analyse the frequency profile of odontogenic cysts and tumours of the jaws in a Portuguese population using the new WHO classification system and to evaluate their clinical-pathological characteristics with a focus on a longitudinal analysis of recurrence. ...
... Odontomas were the 2nd most common odontogenic tumour, similar to the description by Fernandes et al. (16). However, the prevalence of odontomas has shown great variations over the world with high frequency in American and European countries (6,9,11,17) and low in Africa and Asian countries (5,14,20,26,30); interestingly this is the opposite of the pattern observed for ameloblastomas (5). These differences, more than geographic variations, could be related with the hamartomatous nature of these lesions, with few clinical manifestations that could lead to a lower rate of treatment of these lesions and a lower rate of histopathological analysis (5). ...
... This could suggest that the frequency of odontomas could be underestimated in many reports. Unfortunately, data on the recurrence of odontogenic cysts (2,12,13) and odontogenic tumours has been very scarce (10,11,14). Furthermore, we did not find any study using longitudinal analysis of the recurrence-free time interval. ...
Article
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Background: Odontogenic cysts and tumours of the jaws represent one of the most prevalent groups of oral-maxillofacial lesions. We aimed to evaluate the clinical and pathological characteristics of a cohort of odontogenic cysts (OC) and odontogenic tumours (OT) of the jaws in a Portuguese population. Material and Methods: This observational retrospective study analysed patients diagnosed with either an OC or OT of the jaws at a central hospital of Oporto, Portugal, between 1988 and 2006. Data collected from patients' files included demographic, clinical, radiological and histopathological information. Recurrence was evaluated using univariate and multivariate analysis. Results: The sample consisted of 397 patients, 231 males (58.2%) and 166 females (41.8%), with a mean-age of 36.7±17 years. Twenty-seven patients (6.8%) presented with more than one lesion providing a total of 433 lesions. There were 396 (91.5%) OC, mostly represented by radicular cysts (n=257;59.4%), dentigerous cysts (n=79;18.2%), or odontogenic keratocysts (n=50;11.5%). There were 37 (8.5%) OT, mostly represented by amelo-blastomas (n=16;3.7%), and odontomas (n=9;2.1%). The most common initial clinical manifestation was swelling (n=224;51.7%). Recurrence was observed in 30 cases (6.9%), mostly in ameloblastomas (n=6;37.5%) and odontogenic keratocysts (n=12;24%). In the multivariate analysis the diagnosis classification of the lesion was the only independent and significant variable related with the recurrence (P=0.04). Conclusions: Radicular cysts were the most commonly occurring type of OC and ameloblastomas the most commonly occurring OT. Amelobastomas and odontogenic keratocysts were the lesions with the highest rates of recurrence. This large sample provides useful information about the frequency profile and characteristics of OC and OT over a period of 18 years, allowing valuable comparison with data from other countries.
... Central odontogenic fibroma (COF) is an extremely rare benign tumor accounting for only 0.1% of all odontogenic tumors 1 and accounts for 6.1% of all central odontogenic tumors. 2 This lesion is considered to be derived from ectomesenchymal tissue of dental origin such as periodontal ligament, dental papilla, or dental follicle. Clinically, it presents as a slow growing asymptomatic mass which, in most cases, can remain unknown until the appearance of a swelling. ...
... There was no significant predilection for the location either in the maxilla or in the mandible. 2 However, on a retrospective study of 8 clinical cases of COF, Hrichi et al., 10 found a predilection for male sex (1.67:1) and the most common location of the tumor was on the mandible. The average age was 19.9 years with an age range of 11-38 years. ...
Article
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Central odontogenic fibroma is a rare benign tumor accounting for only 0.1% of all odontogenic tumors. A slow growing tumor, usually asymptomatic and is found in routine radiographic examinations. It has been stated that of all odontogenic tumors, this lesion has the most poorly defined parameters. The present case is of a 27 year old female patient having central odontogenic fibroma which was incidentally found on a radiograph. The clinical features and radiographic appearances lead to a diagnostic dilemma between an inflammatory and a tumorous lesion. The diagnosis of the lesion was confirmed on histopathological evaluation after surgical enucleation.
... Currently, this system is widely used for odontogenic tumor classification. Although the incidence of odontogenic tumors has been reported to range from 1 to 9%, studies that were conducted in Asia [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23], Europe [24][25][26][27][28][29][30][31][32], North America [33][34][35][36], South America [37][38][39][40][41][42], and Africa [43][44][45][46][47][48][49][50][51][52][53] have indicated regional differences in the occurrence of odontogenic tumors in different populations, which may have been the result of genetic and cultural differences among people from different geographical regions. ...
... A comparison of the prevalence of the tumors that were of the odontoma and ameloblastoma types revealed a marked difference between different countries. In China [18,21,23] and Nigeria [43], the proportion of odontogenic tumors that were reported to be ameloblastoma was found to be overwhelmingly high, whereas in Greece [29], Canada [36], and the United States [34], the proportion of odontogenic tumors that were identified as odontoma was found to be high. In contrast, the prevalence of ameloblastoma and odontoma was found to be almost equally common in Japan [20] and Turkey [24]. ...
Article
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Several attempts have been made to classify odontogenic tumors; however, the need for a uniform international classification system led the World Health Organization (WHO) to present a classification of odontogenic tumors in 1971. We aimed to evaluate the number and types of odontogenic tumors examined at the Tokyo Dental College Hospital in Japan to determine the frequency and types of odontogenic tumors, based on the 2017 WHO classification system, as this information has not been reported previously in Japan. We also compared the results of our evaluation with those reported in previous studies. We conducted a clinicopathological evaluation of odontogenic tumors examined at the Tokyo Dental College Hospital between 1975 and 2020. This included an analysis of 1089 cases (malignant, n = 10, 0.9%; benign, n = 1079, 99.1%) based on the 2017 World Health Organization Classification of Head and Neck Tumors. We identified 483 (44.3%), 487 (44.7%), and 109 (10.0%) benign epithelial odontogenic, mixed odontogenic, and mesenchymal tumors, respectively. The most common tumor types were odontoma (42.5%) and ameloblastoma (41.9%). Of the 1089 cases, 585 (53.7%) and 504 (46.3%) were male and female patients, respectively. Ameloblastoma and ameloblastic fibroma occurred more commonly in male patients, whereas odontogenic fibroma and cemento-ossifying fibroma affected female patients primarily. The age at diagnosis ranged from three to 87 (mean, 29.05) years. In 319 (29.3%) patients, the age at diagnosis ranged from 10 to 19 years. Ameloblastoma and odontoma were the most common tumor types among patients in their 20s and those aged 10–19 years, respectively. In 737 (67.7%) and 726 (66.7%) patients, the tumors were located in the mandible and posterior region, respectively. Ameloblastoma was particularly prevalent in the posterior mandible. Odontogenic tumors are rare lesions and appear to show a definite geographic variation.
... OF is a rare mesenchymal odontogenic tumor (OT) [1,2]. OTs are diagnosed in 0.74-9.56% of all oral biopsies [8][9][10][11][12][13][14][15]. COFs account for 1.21-4.85% of all OTs [8][9][10][14][15][16]. ...
... OTs are diagnosed in 0.74-9.56% of all oral biopsies [8][9][10][11][12][13][14][15]. COFs account for 1.21-4.85% of all OTs [8][9][10][14][15][16]. COF is rarer than POF [9]. ...
Article
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BACKGROUND Odontogenic fibroma is a rare mesenchymal odontogenic tumor. It can be classified as central odontogenic fibroma (COF) or peripheral odontogenic fibroma (POF) based on clinical features. There are several variants of COF, including amyloid, ossifying, and giant cell. It grows slowly and exhibits painless cortical expansion of the jawbone. Radiographically, COF appears as a radiolucent unilocular or multilocular lesion with well-defined borders. COF may be associated with unerupted or displaced teeth and root resorption. CASE REPORT A 35-year-old man was referred to our hospital for submandibular swelling. Panoramic radiography and contrast-enhanced computed tomography revealed a unilocular area of bone resorption with a well-defined border and equal enhancement from the canine to first molar on the right side of the mandible. Root resorption of the first premolar and root separation of the first and second premolars were also evident. The lesion was asymptomatic. Histopathological examination of a biopsy of the lesion was suggestive of OF. Enucleation of the tumor, curettage of the bone around the tumor, and extraction of the premolar were then performed. Histopathological examination of the tumor showed fibrous connective tissue with inactive-looking odontogenic epithelial islands and strands, amyloid deposit, intercalation of Langerhans cells into the tumor epithelium, and no calcification. The final diagnosis of amyloid variant of COF was made. The postoperative course is going well. CONCLUSIONS Herein we describe and discuss the clinical, radiological, and pathological features of the amyloid variant of COF. This report will enhance understanding of this extremely rare variant.
... Odontoma is the most common odontogenic tumor showing about 75% occurrence rate followed by lower incidences of ameloblastoma and odontogenic myxoma [1]. Odontomas are considered to be hamartomas joining to the developmental anomalies of teeth [2]. ...
... Both lesions are more prevalent in the anterior region of maxilla and mandible, with nearly a same incidence rate in both jaws [5][6][7]. Gender predilection of the incidence of odontoma could not be revealed [1,5]. Histologically compound and complex odontomas may be distinguished; their incidence rate is 2:1 [5]. ...
... Odontoma is the most common odontogenic tumor showing about 75% occurrence rate followed by lower incidences of ameloblastoma and odontogenic myxoma [1]. Odontomas are considered to be hamartomas joining to the developmental anomalies of teeth [2]. ...
... Both lesions are more prevalent in the anterior region of maxilla and mandible, with nearly a same incidence rate in both jaws [5][6][7]. Gender predilection of the incidence of odontoma could not be revealed [1,5]. Histologically compound and complex odontomas may be distinguished; their incidence rate is 2:1 [5]. ...
... [6] Epidemiologically, odontomas are the most frequent odontogenic tumors, accounting for 22%-67% of all maxillary tumors. [7] Buchner et al. [8] examined a sample of 1088 odontogenic tumors and reported an incidence rate of 75.9% of the total. Ragezi et al. [9] examined a sample of 706 jaw tumors and reported that odontomas constituted 67% of their sample. ...
... In addition, some studies from Europe and America have reported ameloblastoma and fibromyxoma as the most common odontogenic tumor, after odontoma. [27] The reason for predilection of ameloblastoma in black Africans is still a subject of speculation. This highlights the value of leveraging multicenter studies to unravel the basis for disparity in aetiology and pathogenesis of dental pathologies across different population groups. ...
Article
Full-text available
Background: Many studies have investigated the burden of odontogenic tumor (OT) in Nigeria; however, the true burden and prevalence of these lesions are not known because these studies are based on a center/region. Aims: Hence, the aim of this study is to evaluate the true burden of OTs in Nigeria, using a multicenter approach. Materials and Methods: This is a 10‑year retrospective cross‑sectional study of OT seen in eight tertiary health institutions in different geographic locations in Nigeria. Results: A total of 990 cases were included in this study. The highest prevalence of OT was in the third decade of life (n = 274, 27.7%). Most lesions were benign (n = 961, 97.1%), with a slight male preponderance; and the mandible was the commonest site (n = 814, 82.2%). There were a significant association between the diagnosed OTs and the age group and site (P = 0.002 and 0.031, respectively). Conclusion: OTs showed a slightly higher preponderance in males, occurring mostly in the third decade. Benign lesions were frequent and ameloblastoma was the commonest OT. Variations exist in the occurrence of OTs from the different geographic locations in Nigeria. This study essentially sheds a broader light on the clinicopathological distribution of OTs across Nigeria, using a large multicenter approach.
... The oldest article dates from the decade of the 1990s [3]. These ten articles found two common topics of interest: immunohistochemical studies [6,7,15,36] and ameloblastoma epidemiology [51][52][53]. Older articles have low chances of being cited, and this frequency decreases over time. ...
Article
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Objectives An increasing number of articles are published each year. The aim of this is to provide a list of the 100 most cited articles on the subject of ameloblastoma. Methods A bibliographic search was performed on Google Scholar (GS), Microsoft Academic (MA), and Dimensions for ameloblastoma. A ranking was created in order of citation density. Graphical representations of keywords and authorship were created with VOSviewer. Statistical analysis was performed and only results with a 95% confidence interval were considered significant. Results A helpful list of top 100 articles was developed to help professionals in a variety of ways. Some curiosities are discussed about this scientometric analysis in ameloblastoma articles. Conclusions A useful list of the top 100 most cited articles on ameloblastoma has been provided. Bibliometric and altmetric analysis using Google Scholar, Microsoft Academic, and Dimensions is a free and excellent tool, not only as a citation manager but also as a study reference.
... [8] The various etiological factors implicated in odontome are elaborated in Table 1. [8,9,11] Various classification systems are devised for odontome, which are compiled in Table 2. [6][7][8][9][10] Clinically, majority of the cases are asymptomatic and are diagnosed when radiographic evaluation is done for some other complaints. In few cases, especially those with complex odontome, there may be a clinically evident expansive lesion. ...
... 3 É o tumor odontogênico mais comum, ocorrendo mais frequentemente nas primeiras duas décadas de vida, sem predileção de sexo. 4,5 Geralmente é assintomático e de crescimento lento, diagnosticado na maioria das vezes por meio de exames de imagem de rotina ou devido à investigação de atrasos na esfoliação de dentes decíduos e erupção de dentes permanentes. 6,7 Os odontomas são classificados em dois tipos: composto e complexo. ...
Article
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RESUMO Odontoma é um tumor odontogênico benigno de origem mista (epitelial e mesenquimal). É subdivi-dido em dois grupos: complexo e composto. Sem predileção para sexo, frequentemente são detec-tados nas duas primeiras décadas de vida por meio de exames de rotina ou por alteração na dentição. Geralmente são assintomáticos e de crescimento lento, podendo ocasionalmente atingir tamanhos consideráveis, causando expansão das corticais ósseas. O tratamento para os odontomas é sua excisão cirúrgica, com prognóstico favorável, sen-do raros os casos recidivantes. O objetivo deste relato é apresentar o caso de uma paciente do sexo feminino, 32 anos, que procurou o serviço de Cirurgia e Traumatologia Bucomaxilofacial do Hospital Regional de Santa Maria para avalia-ção de lesão em mandíbula revelada em exame radiográfico de rotina. Ao exame físico, obser-vou-se aumento de volume em região de ângulo mandibular e em fundo de vestíbulo mandibular direito. O exame de imagem revelou uma lesão hiperdensa localizada na região dos dentes 48 e 47, com abaulamento das corticais ósseas ves-tibular e lingual, e dente 47 incluso associado. A hipótese diagnóstica foi de odontoma complexo. A paciente foi submetida a uma biópsia incisional, e a análise histopatológica confirmou a hipótese diagnóstica. Prosseguiu-se com a remoção parcial da lesão sob anestesia geral, sendo deixada a por-ção inferior em contato com a base mandibular. O diagnóstico final foi de odontoma complexo. Após um ano, a paciente vem sendo acompanhada, sem sinais de recidiva da lesão. A remoção parcial de odontoma complexo de grandes dimensões mostrou-se uma alternativa efetiva, evitando complicações decorrentes da sua remoção total. ABSTRACT Odontoma is a benign odontogenic tumor of mixed origin (epithelial and mesenchymal). It is sub-classified in two types: complex and compound. There is no gender predisposition, and are often detected in the first two decades of life through routine examinations or changes in dentition. Odontomas are generally asymptomatic, they possess limited and slow-growing potential, but may occasionally reach considerable sizes, causing expansion of the corti-cal bone. The treatment for odontomas is surgical
... Both of these lesions are diagnosed in the second and third decade of life similar to an AOT, but they are more common in the posterior regions of the mandible. The calcifying cystic odontogenic tumor (CCOT) also mimics an AOT since it is observed in the anterior region of jaws which may be associated with an unerupted tooth and presence of radio-opacities and diagnosed in the second decade [12]. Permanent canines are the most common unerupted teeth associated and are etiological in around 74% of all cases reported and maxillary canines are the most common amongst them. ...
... In addition, some studies from Europe and America have reported ameloblastoma and fibromyxoma as the most common odontogenic tumor, after odontoma. [27] The reason for predilection of ameloblastoma in black Africans is still a subject of speculation. This highlights the value of leveraging multicenter studies to unravel the basis for disparity in aetiology and pathogenesis of dental pathologies across different population groups. ...
Article
Full-text available
Background: Many studies have investigated the burden of odontogenic tumor (OT) in Nigeria; however, the true burden and prevalence of these lesions are not known because these studies are based on a center/region. Aims: Hence, the aim of this study is to evaluate the true burden of OTs in Nigeria, using a multicenter approach. Materials and Methods: This is a 10‑year retrospective cross‑sectional study of OT seen in eight tertiary health institutions in different geographic locations in Nigeria. Results: A total of 990 cases were included in this study. The highest prevalence of OT was in the third decade of life (n = 274, 27.7%). Most lesions were benign (n = 961, 97.1%), with a slight male preponderance; and the mandible was the commonest site (n = 814, 82.2%). There were a significant association between the diagnosed OTs and the age group and site (P = 0.002 and 0.031, respectively). Conclusion: OTs showed a slightly higher preponderance in males, occurring mostly in the third decade. Benign lesions were frequent and ameloblastoma was the commonest OT. Variations exist in the occurrence of OTs from the different geographic locations in Nigeria. This study essentially sheds a broader light on the clinicopathological distribution of OTs across Nigeria, using a large multicenter approach.
... Calcifying odontogenic cysts account for less than 2% of all central odontogenic entities [6], but represent 90% of ghost cell lesions of the jaws [1,3]. COCs usually present during the second and third decades of life with an almost equal gender distribution (1.2:1 male-to-female ratio) [3,7,8]. ...
Article
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Ghost cell odontogenic carcinoma (GCOC) is a rare malignant neoplasm, representing 3% of all ghost cell lesions of the jaws. They can arise de novo or from a pre-existing calcifying odontogenic cyst (COC) or dentinogenic ghost cell tumour (DGCT). A systematic review of the literature reported only 12 cases of a GCOC arising from a pre-existing COC. This report highlights an additional case of a GCOC arising from a pre-existing COC after 3 years in an adolescent male. The patient initially presented with a painless swelling of the right mandibular corpus. Panoramic radiographic examination showed an expansive unilocular radiolucent lesion. After 3 years, the radiographic features appeared more aggressive with increased expansion and cortical perforation. A wide surgical resection was performed, whereby the lesion was diagnosed as a GCOC. Due to the rarity of these malignant neoplasms, limited information is available regarding their biological behaviour. One-year follow-up revealed no clinical signs of recurrence.
... This may be correlated with the presentation of patients to hospital only in the presence of debilitating symptoms in developing nations complicated by lack of regular dental/medical checkups. On the contrary, ameloblastomas are frequently detected during routine dental check-ups in developed countries with better healthcare norms [16]. It has been reported that UA tends to occur at a lower age as compared to solid multicystic variants of ameloblastoma [11]. ...
Article
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Unicystic ameloblastoma (UA) is an uncommon variant of ameloblastoma and behaves totally different from the solid multicystic variant of ameloblastoma (SMA); furthermore the histological subgroups of UA also show varied behavior regarding proliferation. The present multi-centric study was designed to present the clinicopathological features of unicystic ameloblastoma (UA) and to compare the two popular histological classifications systems. 80 satisfactory cases of UA were retrieved and evaluated for clinicopathological parameters from four teaching dental schools of North India. The cases were classified using modified Reichart and Philipsen system and Marx and Stern system followed by comparison of inter-observer variability. The results were analyzed using SPSS software. The mean age of occurrence was 30.79 ± 16.49 years. Males outnumbered females (M:F::1.67:1). The majority of cases occurred in the third decade irrespective of the gender. Most cases were found in body–angle–ramus region of the mandible. The modified Reichart and Philipsen classification yielded better interobserver agreement (kappa value 0.845). The modified Reichart and Philipsen classification yields better inter-rater agreement and is easy to reproduce amongst oral pathologists. Being simpler it may easily be understood by the operating surgeon for better treatment outcome.
... The general clinical aspects (e.g. age, lesion localization and symptoms) of this case are in consonance with those previously described in the literature for COC [4,14]. Although the incidence of COC is mostly in the second decade of life, this lesion may occur at any age. ...
... The OF accounts for about 4.1% of all odontogenic tumors [5] and represents 1.5% of all central odontogenic tumors [6]. It has a wide patient age range, between 3 and 77 years [1,5,7]. ...
Article
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A patient with an odontogenic fibroma (OF) with the presence of fibroblasts of varying morphology is presented, and the main microscopic differential diagnosis is discussed. Case report: a 51-year-old man complained of a swelling in the anterior region of the mandible. The panoramic radiograph showed a radiolucent, well-defined multilocular image, with displacement of the roots of the left mandibular incisors and canine. A cone beam computed tomography examination revealed a hypodense image, with delicate bone spicules inside, divergence of the tooth roots and destruction of the buccal cortical bone. Under the differential diagnosis of a desmoplastic ameloblastoma or a squamous odontogenic tumor, an incisional biopsy was made. Microscopically, deeply collagenized tissue with scarce odontogenic epithelium islands, large fibroblasts of varying morphology and calcified material was observed. A diagnosis of OF was made. Surgical removal was carried out, and the specimen was examined. Identical aspects were found, and the immunohistochemical reaction for pan-cytokeratin was carried out to identify the odontogenic epithelial cells. The definitive diagnosis of OF was confirmed, and we emphasize the importance of the correlation of all characteristics for a definitive diagnosis.
... WHO defined the tumor as "a locally invasive neoplasm that consists of angular and rounded cells in mucoid background" [2]. A worldwide estimated incidence of OM ranges from 0.5 to 17.7% from all odontogenic tumors of the jaw [3][4][5][6][7][8][9][10]. The wide range of incidence rates might be attributed to over-diagnosing normal odontogenic entities in the absence of clinical correlation and/or misinformation from the submitting clinicians. ...
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Odontogenic myxoma (OM) is an uncommon benign odontogenic tumor arising in the jaw. Though it has slight histologic overlap with other entities, definitive diagnosis is imperative considering the tumor’s aggressive nature, high recurrence rate, and necessity of radical surgical intervention in large-sized lesions. With IRB approval, a retrospective search of the University of Florida College of Dentistry Oral Pathology Biopsy Service archives from 1994 to 2017 for diagnosis of OM of the jaw was performed. Biopsy reports and original slides for each case were assessed and reviewed along with any accompanying radiographs to confirm the diagnosis. Immunohistochemical staining was utilized to exclude entities with histologic overlaps, such as intraosseous myxoid neurofibroma. A total of 38 cases were included. The patients’ age ranged from 6 to 84 years, with a mean age of 37.47 years. Females comprised two-thirds of the cases (n = 25) versus males (n = 13). The mandible was the most affected at 60.5% (n = 23), followed by maxilla 39.4% (n = 15). Posterior jaw involvement was higher than anterior in both the mandible (n = 20 versus n = 3) and the maxilla (n = 11 versus n = 4). Most lesions presented clinically as expansile masses with variable radiographic appearance. The clinical impression from submitting providers included “gelatinous masses”, abscesses, odontogenic lesions, fibro-osseous lesions, soft tissue or bone neoplasms, and reactive gingival lesions. A consensus of odontogenic myxoma as a diagnosis was rendered for 30 cases (79%), while in 8 cases (21%) that exhibited a more fibrous stroma was identified as fibromyxoma. OM may exhibit a varied demographic and clinical profile with a wide spectrum of histologic presentations. Pathologists should be sentient of this variability in order to arrive at an accurate diagnosis and correctly manage these patients.
... Responses to the educational objectives Epidemiology COF is considered by the WHO to be a rare tumour but no epidemiological data are shown [1]. It represented 1.5% of central odontogenic tumours (16 cases out of 1088 biopsied tumours) [3]. This was probably an overestimate since histological variants of COF (such as ossifying odontogenic fibroma) that are no longer recognized by the WHO have been accounted for. ...
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Abstract - Introduction: Central Odontogenic Fibroma (COF) is a rare benign odontogenic tumour of the jaws. Until its recent change in classification by the WHO in 2017, this entity has gone without an agreed upon definition for many years. For this reason, COF would remain largely unknown to practitioners. Corpus: The pedagogical objectives of this article are, through a systematic review of the literature using the PRISMA methodology, to list the epidemiological, aetiological, clinical, radiological, histological, therapeutic and prognostic characteristics of COF. All the data collected made it possible to establish a COF management summary for practitioners in order to optimize it. Conclusion: Based on the 135 cases listed, it appears that surgical enucleation is the treatment of choice for COF. The recurrence rate is low and malignant transformation has never been reported. However, regular clinical and radiological follow-up of patients over several years seems to be a justified precaution.
... COCs account for less than 2% of all central odontogenic lesions, 21,22 and represent 90% of ghost cell lesions of the jaws. 7,14 Simple cystic COCs (Type 1) represent the most common subtype (70%), followed by Type 2 (24%). ...
Article
Objective Calcifying odontogenic cysts (COCs) exhibit diverse clinical behaviours, and may be associated with other benign odontogenic tumours. In this study, the clinical and radiological features of COCs were analysed according to subtypes based on the classification by Praetorius et al. Emphasis was placed on cases exhibiting atypical or aggressive radiological appearances. This information may assist the clinician to better understand the radiological spectrum of COCs. Methods Histologically confirmed cases of COCs were retrospectively reviewed in a 20 year period from three tertiary institutions. The following clinical information was reviewed: patient demographics, main complaint, clinical duration, anatomical site and detailed radiological features. Results Twenty-seven cases of COCs were included in the study. Asymptomatic swelling was the main clinical presentation with infrequent reports of associated pain. COCs had an anterior mandibular predilection. Well-demarcated borders were seen in all cases with isolated cases showing focal areas with loss of demarcation. Unilocular lesions were more common than multilocular variants. Internal calcifications were frequent and six cases presented with associated odontomas. Maxillary COCs resulted in the displacement of the maxillary sinus and/or nasal cavity walls. Radiological signs of aggression, including cortical destruction, were noted in a few cases. Conclusion Given the fact that COCs can present with a spectrum of clinical behaviours and radiological presentations, the academic debate regarding the cystic versus neoplastic nature of the entity is justifiable. The cases in the current sample presented with diverse clinical behaviours and radiological presentations, ranging from indolent to lesions with significant growth and aggression.
... The frequency of the malignancy in an ameloblastoma is estimated to be less than 1% [1]. Ameloblastic carcinoma is not very common with an incidence of around 1-3% of all odontogenic tumors [2][3][4][5]. According to the World Health Organisation, ameloblastic carcinoma is classified under the group of odontogenic carcinomas [6,7]. ...
... [7] Buchner et al. reported the incidence of odontoma to be as high as 75.9% in all odontogenic tumors. [8] In 2002, Ochsenius et al. analyzed a sample of 362 odontogenic tumors in which odontomas represented 44.7%. [9] These tumors may cause the impaction of teeth and expansion of bony cortical plate, as was seen in this case. ...
Article
Odontomas are the most common odontogenic tumors. They are considered to be hamartomas rather than neoplasms and are composed of enamel, dentin, cementum, and pulp tissue. These lesions are considered benign; however, they often cause disturbances in eruption of the associated tooth. Early diagnosis and removal of an odontoma associated with a primary tooth are essential to prevent any further disturbance in the dental arch. Odontomas occur more frequently in the permanent dentition and are very rarely associated with the primary teeth. This report presents a rare case of compound odontoma associated with unerupted primary canine and its management. The adoption of a conservative surgical approach is advisable, in order to preserve the dental tissues and achieve optimal tissue healing.
... Myxomatous odontogenic tumors (MOTs), including odontogenic myxoma (OM), is the third most common odontogenic tumor after ameloblastoma and odontomas, comprising for 3% to 20% of all odontogenic tumors [1][2][3][4] . The "odontogenic myxoma" entity was first described by Thoma and Goldman 5 in 1947. ...
Article
Objectives: Myxomatous odontogenic tumors (MOTs) are the third most common odontogenic tumors in the oral and maxillofacial region. Due to its slow-growing, but locally invasive nature, the tumor is usually detected by accident or only when it becomes a large mass, which causes facial deformity. Materials and methods: Current study reports three unusual cases of MOT including huge myxoma involve the mandible in middle-aged man, MOT with ossifying fibroma pattern in mandible, and MOT in maxilla of young female patient. The diagnosis and treatment strategy of MOTs was also summarized and updated. Results: In reported three cases of patients with large MOTs, surgical treatment was indicated with fibular free flap reconstruction in the mandible and plate reconstruction in the maxilla. The tumors were successfully treated with radical resection and did not show signs of recurrence during the follow-up period. Conclusion: Surgical treatment indication depends on size, the position of the lesion, patient systemic condition and surgeon individual experience. In the case of a large tumor, radical resection and reconstruction is the standard surgical strategy. The conservative surgical treatment including enucleation with wide curettage is still under controversy. The recurrence rate for MOTs is significantly high, up to 30%, therefore long-term follow-up is essential.
... The overall prevalence of congenitally missing teeth is reported to be 4% wherein mandibular pre-molars (excluding III molars) are found frequently missing. Thus, the present study was in accordance with studies by Uner et al. and Moyers et al. 19,20 WHO recognizes odontoma as the most common odontogenic tumor (35-76%) 21 in which compound odontome are more frequently found (9-37%) than complex odontome. Thus, our results can be well correlated where compound odontome was a major IF among the odontomas. ...
... Odontomas are clinically significant because they cause eruption disturbances such as impaction or delayed tooth eruption, retention of a primary tooth, abnormalities in tooth position and tipping or displacement of adjacent tooth. 4,5 This article presents a case of a compound odontoma located between the maxillary left central and lateral incisor, associated with distal displacement and mesial angulation of the lateral incisor. Minimal traumatic management protocols were initiated and there was a successful treatment outcome. ...
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Introduction: Odontomas are the most common odontogenic tumors worldwide and are usually chance findings seen on routine dental examinations. However, on progression, they may be associated with adjacent tooth displacement. Case description: We report a case of an 11-year-old girl who presented at the Lagos University Teaching Hospital (LUTH) pediatric dental clinic with a complaint of painless enlargement of the left anterior maxilla of 2-years duration. The swelling was located between teeth 21 and 22 and was associated with distal displacement and mesial angulation of tooth 22. Clinical, radiographic and histopathologic investigations revealed a compound odontoma. Surgical exposure and enucleation was done to remove the tumor. The patient's postoperative course and 6 months follow-up were uneventful. Conclusion: This report elucidates the importance of routine dental check-ups and minimally traumatic management of odontomas in pediatric dental patients to prevent adverse effects of odontomas, thereby, minimizing the interventions needed after surgical enucleation.
... Several studies have proven the rarity of COC lesions, estimated as corresponding to 1% to 3% of all odontogenic cysts and tumors. 15,16 In addition, the peak occurrence of this type of lesion is between the second and third decades of life. 8,17 Thus, since the patient in this case report was 66 years old at the time of diagnosis, he may have been diagnosed late, which would explain the greater bone growth and expansion observed. ...
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A calcifying odontogenic cyst may be associated with odontogenic tumors, particularly odontomas. However, the association between calcifying odontogenic cysts and odontogenic cysts is rare. This study aims to report the first case of a calcifying odontogenic cyst associated with an antral pseudocyst. A male patient presented a tumor lesion in his right maxillary alveolar ridge with 6 months of evolution and painful symptoms . An excisional biopsy was performed, and a histopathological diagnosis of calcifying odontogenic cyst associated with an antral pseudocyst was issued. The treatment of choice was lesion enucleation and curettage. The patient has been under follow-up for about 3 years without lesion recurrence, which is typical indolent calcifying odontogenic cyst behavior.
... The high frequency of unicystic AME was in agreement with the study by Luo et al. (31.17%) and comparable to other studies in USA (46%) and Estonia (31.6%). 4,12,37 However, it was in contrast to other studies showing a low prevalence of unicystic variant. 43,44 All subtypes (except DA in anterior mandible) occurred predominantly in the posterior mandible, which was in agreement with literature findings. ...
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Introduction The classification of odontogenic tumors has been revised from time to time in order to provide unified terminology. This reclassification had considerable impact on their prevalence and frequency distribution. Objectives This study was aimed to emphasize impact of changing classification systems on prevalence and relative frequency of odontogenic tumors. The secondary objective was to analyze demographics of various histological types of odontogenic tumors in comparison to published literature. Review of Indian studies (1992–2020) elaborating frequency of odontogenic tumors is summarized in the end. Methods This was a hospital-based retrospective study wherein case files of odontogenic tumors diagnosed from 1990 to 2019 period were retrieved. The classification system used originally at the time of diagnosis was retained and prevalence of odontogenic tumors in three different periods (1990–2004, 2005–2016 and 2017–2019) was compared. Further, prevalence, frequency distribution and demographics of all these tumors (1990–2019) were analyzed using latest WHO 2017 classification. Results A total of 345 odontogenic tumors was diagnosed as per WHO 2017 system of classification from 1990 to 2019. 96.81% tumors were benign and 3.81% constituted malignant odontogenic tumors. However, there was marked increase in prevalence of odontogenic tumors in 2005–2016 (6.2%) period as compared to 1990–2004 (3.87%) and 2017–2019 (3.47%). Ameloblastoma remained the most common tumor in three different periods, whereas keratocystic odontogenic tumor became second commonest tumor in 2005–2016 as compared to odontoma in 1990–2004 and adenomatoid odontogenic tumor in 2017–2019. Conclusions The continuous evolving systems of classification may partly be responsible for inconsistency in odontogenic tumors, with inclusion of keratocystic odontogenic tumor,and has marked impact on prevalence and frequency distribution of odontogenic tumors. The geographical variations in demographics of odontogenic tumors might reflect genetic and environment influence; however it requires elucidation by further studies.
Article
Odontogenic myxofibroma is a benign odontogenic tumor of mesenchymal tissue that generally originates from the mandible. It is an extremely rare tumor accounting for approximately 2% of all odontogenic tumors. In this report, the authors presented a giant right mandibular mass that extends to the angle of the mandible and displacing the tongue laterally caused significant malocclusion, pain, and impaired oral intake. The tumoral involvement of the mandibula required a partial mandibulectomy with the resection of right mandibular ramus, body, and bilateral parasymphysis. Right mandibular condyle was preserved. The mandibular defect was reconstructed with a fibula free flap. Three-dimensional printed maxillofacial bone model of the patient was used as contour modeling and guide. Histopathologic examination confirmed the diagnosis as odontogenic myxofibroma.The purpose of the report is to present a very rare case of odontogenic myxofibroma and its general characteristics, radiological features, differential diagnosis, surgical management, and the use of three-dimensional printing technology in the field of mandibular reconstruction.
Chapter
Odontogenic cysts and tumors represent a surprisingly diverse group of lesions of the jaws and overlying soft tissues. In general, odontogenic cysts may be developmental or inflammatory in origin. Developmental odontogenic cysts include the following: the dentigerous cyst, eruption cyst, odontogenic keratocyst, orthokeratinized odontogenic cyst, gingival cyst of the newborn, gingival cyst of the adult, lateral periodontal cyst, glandular odontogenic cyst, and calcifying odontogenic cyst. Inflammatory odontogenic cysts include periapical cysts and residual periapical cysts. In general, odontogenic cysts are benign, although malignant transformation is possible. Benign odontogenic tumors may be subclassified as follows: (1) epithelial (including ameloblastoma, calcifying epithelial odontogenic tumor, squamous odontogenic tumor, and adenomatoid odontogenic tumor); (2) mixed epithelial and mesenchymal (including ameloblastic fibroma, ameloblastic fibroodontoma, odontoma, primordial odontogenic tumor, odontoameloblastoma, and dentinogenic ghost cell tumor); and (3) mesenchymal (including central odontogenic fibroma, peripheral odontogenic fibroma, granular cell odontogenic tumor, and odontogenic myxoma). Furthermore, there are several types of malignant odontogenic tumors, including metastasizing ameloblastoma, ameloblastic carcinoma, primary intraosseous squamous cell carcinoma, clear cell odontogenic carcinoma, ghost cell odontogenic carcinoma, intraosseous mucoepidermoid carcinoma, ameloblastic fibrosarcoma, and odontogenic carcinosarcoma. The diversity of odontogenic cysts and tumors can be difficult to understand without basic knowledge of the process of odontogenesis. Hence, we begin with a review of the histology and embryology of tooth formation. In addition, clinical correlation is often essential for accurate diagnosis. Therefore we discuss the clinical features, as well as pathologic features, differential diagnosis, treatment, and prognosis for each entity.
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An 89-year-old woman visited our hospital requesting the examination of a papillary mass in the posterior region of the right buccal mucosa. The orthopantomography and contrast-enhanced CT images showed a mass lesion existing near the mandibular ramus toward the muscular process, the posterolateral maxilla and the temporal fossa. The boundary of the lesion was unclear. Biopsy was taken twice and the general pathologists tentatively diagnosed the lesion as papilloma. However, since the lesion seemed invasive, we and an oral pathologist suspected the lesion as possibly invasive tumor, and surgical resection was performed. The histopathological diagnosis of the surgical specimen was a mixed lesion of plexiform- and acanthomatous-type ameloblastoma. Immunohistochemistry revealed CK19 (-), CK7 (-), p16(+), Ber-EP4(-), which supported the diagnosis as ameloblastoma. Possible mutations of BRAF and PTCH1 was suggested by whole exome sequencing. By accumulating the histopathological, immunohistochemical and genetical investigations, we may be able to lead an accurate diagnosis for odontogenic tumors, and a further planning of the treatment.
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Ameloblastoma é o tumor odontogênico de maior relevância clínica que acomete os maxilares, de agressividade local e alto índice de recidiva após tratamentos conservadores. O ameloblastoma corresponde a 1% de todos os tumores odontogênicos, e acomete principalmente a porção posterior do osso mandibular. Sua incidência é preferencialmente na terceira e quarta década de vida, e a variante multicística é a mais comum. Embora existam diversos tipos de tratamentos, como a crioterapia, enucleação, marsupialização entre outros, os índices de recidiva ainda são representativos, o que justifica a realização de mais estudos acerca do tema. Os objetivos do presente trabalho foram realizar um estudo epidemiológico de 60 casos clínicos de ameloblastomas tratados no Hospital Batista Memorial de Fortaleza no período de 2000 a 2015 e analisar as recidivas de acordo com parâmetros clínicos, cirúrgicos e histopatológicos. Para isso, eve como objetivo de realizar um levantamento epidemiológico dos pacientes com tumor odontogênico do tipo ameloblastoma tratados no Hospital Batista Memorial de Fortaleza, Ceará, observando aspectos clínicos, radiográficos, tratamento cirúrgico, padrões histopatológicos e prognósticos dos mesmos num período de 15 anos de funcionamento do serviço de CTBMF e teve-se como uma amostra de um total de 60 pacientes , com os ambos os gêneros, prevalecendo o gênero feminino (58,3%)foi avaliada. A média da idade dos pacientes foi de 43.13 anos. A região anatômica mais acometida foi a mandíbula, na região posterior (81,7%). O número de pacientes com radiolucência unilocular foi significativo (60%). O padrão folicular foi o mais comum (36,7%). Um total de 24 pacientes foram tratados através de enucleação com curetagem e apenas 11,7% dos pacientes não foram submetidos a receberam tratamento adjuvante. Nos casos avaliados foi observada uma taxa de recidiva de 30%, sendo que as abordagens cirúrgicas radicais representaram 16,7% dos casos. De acordo com o presente estudo, o perfil epidemiológico da população estudada guarda relação quando comparado aos demais estudos epidemiológicos de ameloblastoma, no entanto, a mistura de raças característica da população nordestina pode trazer alterações na prevalência por cor da pele do indivíduo. Não foi observada relação entre os achados clínicos, padrão histológico ou modalidade terapêutica com o índice de recidiva da lesão, no entanto, observou-se que houve relação entre o tamanho da lesão e a presença de dentes inclusos associados.
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Odontogenic tumors (OTs) are a heterogeneous group of lesions originating from the remnants of the tooth‐forming apparatus (Nalabolu et al., 2016). The frequency rates of OTs vary from about 1% to 32% of all jawbone tumors (Adebayo et al., 2005; Sekerci et al., 2015).
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Ameloblastoma is an odontogenic neoplasm characterized by slow intraosseous growth with progressive jaw resorption. Recent reports have revealed that ameloblastoma harbours an oncogenic BRAF V600E mutation with mitogen‐activated protein kinase (MAPK) pathway activation and described cases of ameloblastoma harbouring a BRAF V600E mutation in which patients were successfully treated with a BRAF inhibitor. Therefore, the MAPK pathway may be involved in the development of ameloblastoma; however, the precise mechanism by which it induces ameloblastoma is unclear. The expression of ADP‐ribosylation factor (ARF)‐like 4c (ARL4C), induced by a combination of the EGF‐MAPK pathway and Wnt/β‐catenin signalling, has been shown to induce epithelial morphogenesis. It was also reported that the overexpression of ARL4C, due to alterations in the EGF/RAS‐MAPK pathway and Wnt/β‐catenin signalling, promotes tumorigenesis. However, the roles of ARL4C in ameloblastoma are unknown. We investigated the involvement of ARL4C in the development of ameloblastoma. In immunohistochemical analyses of tissue specimens obtained from 38 ameloblastoma patients, ARL4C was hardly detected in non‐tumour regions but tumours frequently showed strong expression of ARL4C, along with the expression of both BRAF V600E and RAF1 (also known as C‐RAF). Loss‐of‐function experiments using inhibitors or siRNAs revealed that ARL4C elevation depended on the RAF1–MEK/ERK pathway in ameloblastoma cells. It was also shown that the RAF1–ARL4C and BRAF V600E–MEK/ERK pathways promoted cell proliferation independently. ARL4C‐depleted tumour cells (generated by knockdown or knockout) exhibited decreased proliferation and migration capabilities. Finally, when ameloblastoma cells were co‐cultured with mouse bone marrow cells and primary osteoblasts, ameloblastoma cells induced osteoclast formation. ARL4C elevation in ameloblastoma further promoted its formation capabilities through the increased RANKL expression of mouse bone marrow cells and/or primary osteoblasts. These results suggest that the RAF1–MEK/ERK–ARL4C axis, which may function in cooperation with the BRAF V600E–MEK/ERK pathway, promotes ameloblastoma development. This article is protected by copyright. All rights reserved.
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Objetivo: Determinar la frecuencia de odontomas a través de radio- grafías panorámicas digitales en pacientes pediátricos atendidos en el Centro Dental Docente Asistencial de la Universidad Peruana Cayeta-no Heredia durante el periodo 2015 -2018.Material y métodos: El presente estudio es de tipo descriptivo, transversal, y retrospectivo con un total de 2707 radiografías panorámicas digitales de pacientes pediátricos de 3 a 17 años tomadas en el centro dental docente asistencial de la Universidad Peruana Cayetano Heredia durante el periodo 2015 – 2018.Resultados: Se encontró un total de 34 odontomas (1,26%) de los cuales el 53,60% (n=20) corresponden al sexo femenino y 46,40% (n=14) al sexo masculino, la edad dental más frecuente fue en la dentición permanente con un 41,18% (n=14) el odontoma compuesto fue la entidad más frecuente con un 52,94% (n=18), y ambas entidades se localizaron en la zona anatómica anterosuperior, la cual es más común con 64,71% (n=22). Conclusiones: El odontoma presentó una baja frecuencia en pacientes pediátricos en el centro dental de la Universidad Peruana Cayetano Heredia durante el periodo 2015-2018.
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The use and importance of cone beam computed tomography (CBCT) in the diagnostic, treatment and long term follow up of odontogenic tumours, as well as one reconstruction and dental implants rehabilitation is reported. This clinical series shows diagnosis of odontogenic tumors using selected and used CBCT for initial diagnosis, morphological characterization, and follow up for 5 to 10 years. The CBCTs showed the size and form of the tumor and the follow up showed a satisfactory remodelling of bone and the success in the rehabilition with dental implants. No signs of recurrence were observed. The conventional radiographies, Fan Beam CT, Cone Beam CT and Magnetic Resonance Imaging (MRI) are discussed in the use for follow up of odontogenic tumors. It is concluded that CBCT is an efficient tool for diagnosis, follow up and assessment of the morphology and size of the tumor in order to achieve the best treatment plan, returning the functional conditions to the patients.
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jats:title>Abstract Tumors of the jaws represent a heterogeneous group of lesions that are classified histologically in the World Health Organization Classification of Odontogenic Tumors (2017). This article provides an update of the current nomenclature. The main role of imaging is to describe the precise location and extent of these lesions. Although characterization of imaging is often difficult due to overlapping characteristics, imaging is helpful to define which lesions should be referred for histologic examination and subsequent treatment planning. Location and density are the cardinal criteria for potential characterization on imaging. Radiologically, lesions may be radiolucent, radiopaque, or of mixed density. Additional criteria include lesion demarcation, morphology, cortical breakthrough, periosteal reaction, and adjacent soft tissue changes. Final lesion characterization is only definitive after interdisciplinary discussion and radiopathologic correlation. Correct diagnosis is obtained by a combination of the patient's age, lesion location, and clinical and radiologic presentation. It is important that all physicians use a uniform nomenclature.</jats:p
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The ameloblastic fibrodentinoma is a mixed tumor, composed by odontogenic epithelium that induces odontogenic mesenchyma to form dentine or products similar to dentine. Lesions have been reported in young patients, between the first or second decade of life, and usually diagnosed before they become 20 years old. Lesions are asymptomatic and with a slow growth behaviour. Radiographically, it is observed as an unilocular or multilocular radiolucency with well-defined borders, radiopaque material could be dispersed troughout the lesion. The treatment is based on enucleation with fully osseous curettage. The objective of this article is to report the case of a 1-year-old female patient with an ameloblastic fibrodentinoma on the right side of the mandible.
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A proper antibody panel selection is one of the most important factors to reach an adequate diagnosis in challenging cases. This retrospective study was designed to determine the contribution of immunohistochemistry (IHC) in the primary diagnosis of oral diseases in one of the main services of oral pathology in the State of São Paulo, Brazil, and to identify the most common antibodies used, and recommend diagnostic algorithms based on our experience with challenging lesions. A total of 1698 IHC stains were performed in 401 cases from a total of 28,804 cases received from public dental clinics and private dental practitioners within a period of 13 years, representing a frequency of 1.4% of IHC solicitations. Among these, 112 (28%) were mandatory to reach a final diagnosis and 255 (63.6%) were confirmative. In 34 (8.4%) cases, it was not possible to reach a conclusive/final diagnosis, even with IHC. Regarding the nature of the lesions, 210 (52.3%) were benign, 163 (40.6%) were malignant tumors, 13 (3.2%) were reactive, 10 (2.5%) were premalignant, and 5 (1.2%) were lesions of uncertain malignancy. Small amount of tissue of some incisional biopsies, overlapping features of spindle cell lesions (epithelial, neural, melanocytic, smooth muscle, endothelial, and fibroblastic/myofibroblastic cell differentiation), and overlapping features of salivary gland lesions were the most frequent challenges in which IHC stains were requested. Spindle cell lesions were the most frequent (22%) among all cases that required IHC to reach a final diagnosis. The implementation of IHC for routine practice requires a wide range of markers, proper antibody selection, and knowledge to interpret the subjectivity of staining. The inherent limitation of incisional biopsies was pointed as a reason to inconclusive diagnosis, despite a wide range of antibodies that our laboratory displays.
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Odontomas are one type of benign odontogenic hamartoma that includes the compound and complex odontoma. They are generally reported not to exceed 3 cm in diameter. Odontomas with a diameter exceeding 3 cm are considered giant odontomas. An accurate diagnosis of odontomas cannot be made during the clinical examination. The majority of compound odontoma is diagnosed most commonly during radiographic screening. It should be done in coordination with a histological examination after surgical treatment. We report a case of giant compound odontoma of the mandible in a young boy. The tumor is treated by surgical excision under general anesthesia.
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Background: The clinical manifestations of these lesions comprises pain, paresthesia, swelling, drainage, tooth loss, root resorption, and facial deformity. Alteration in oral and maxillofacial (OMF) tissues of the lesions may cause esthetically and functionally unfavourable effects in patients. Aims and objectives: To determine the frequency of odontogenic cysts, tumors, and other lesions. Materials and methods: Patient's records of histopathological reports from the archives of the Department of Oral and Maxillofacial Pathology were obtained and reviewed over a period of 2 years, and therefore, the lesions were classified into four groups. In cases of recurrent lesions, only the primary diagnosis was considered. The research protocol was approved by the ethical committee of the institution. Results: About 56.4% of males had ameloblastoma, 54.9% of females had cementoma. 59.4% females had giant cell granuloma, 87.5% females had pyogenic granuloma, 77.2% females had osteoma, 65.1% of the female population were belongs to the benign fibro-osseous lesions and 50.2% of females were from fibrous dysplasia in group 3. About 58.8% females had squamous cell carcinoma in group 4. Conclusion: To adequately determine the prevalence and incidence rate of OMF lesions, biopsies performed by other specialists such as otolaryngologists and plastic surgeons in OMF regions should also be evaluated.
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Résumé Les tumeurs maxillo-mandibulaires, souvent sources de difficultés diagnostiques pour les radiologues, sont d’une grande diversité reflétant la variété de ses composants tissulaires (tissus osseux, cartilagineux, dentaires, mésenchymateux, nerveux, vasculaires…). L’enjeu de ce travail est d’établir, à travers une revue iconographique des lésions tumorales et pseudo-tumorales maxillo-mandibulaires, un guide d’analyse radiologique de ces lésions, notamment les plus fréquentes et celles présentant des signes radiologiques spécifiques. Certaines de ces lésions demeurent non caractérisables en imagerie et seules les données anatomopathologiques peuvent permettre leur diagnostic. Une analyse successive des tumeurs odontogéniques, puis des lésions osseuses bénignes et malignes et leurs diagnostics différentiels sera effectuée. Au sein de la pathologie osseuse bénigne, la dysplasie fibreuse est souvent surdiagnostiquée, aux dépens notamment des autres lésions fibro-osseuses (dysplasie cémento-osseuse…) ou des ostéites (septiques ou aseptiques), dont nous discuterons les éléments radiologiques clés pour approcher ces diagnostics. Enfin, les pathologies malignes, du fait de leur gravité et de l’importance pronostique de leur diagnostic précoce, seront également explicitées, en insistant sur les signes radiologiques de malignité à ne pas méconnaître, notamment pour les lésions osseuses.
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Peripheral odontogenic myxoma of the oral cavity is extremely rare. We present a case of peripheral myxoma arising from the mandibular anterior lingual gingiva in a 55-year-old man. Intraoral examination revealed a solitary, elastic-hard mass on the lingual gingiva of the mandibular in the range of right first incisor to canine, measuring 13mm in diameter. The mucosa of the mass was partially white in color, and the shape of the mass was slightly irregular. Abnormal uptake FDG on PET/CT (SUVmax 9.9) was observed in the anterior mandible. The mass was excised with a margin of healthy gingiva. The histopathologic diagnosis was peripheral odontogenic myxoma. Follow-up for 2 years after excision has shown no evidence of recurrence.
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Odontomas, the benign odontogenic tumors of epithelial and mesenchymal origin, are very common in occurrence and are now widely accepted as hamartomas. Odontomes are invariably composed of enamel and dentin, and may also have variable amounts of cementum and pulp. Largely, odontomas have been categorized into the compound and complex varieties. Compound odontoma epitomizes itself as aberrations with the presence of all types of dental tissues and showing an orderly distribution in the form of tooth-like structures; whereas complex odontoma describes itself as aberrations in which the presence of some or all dental tissues and in a disorganized distribution. Herein, a case of compound-complex odontome associated with the impaction of a mandibular second premolar is being presented in a 13-year-old girl. How to cite this article: Ahuja VR, Jayanna R, Ahuja A, et al. Impacted Mandibular Premolar Concomitant with Compound-Complex Odontome in a 13-year-old Girl: A Case Report. Int J Clin Pediatr Dent 2020;13(6):729-733.
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Ameloblastic fibro-odontoma (AFO) is a benign, epithelial odontogenic tumour with odontogenic mesenchyme. It shows histologic features of both ameloblastic fibroma and complex odontoma. It is a rare mixed odontogenic tumour. It occurs predominantly in children and young adults, with a slight predilection for males. It is often located in the posterior aspect of the mandible. It may either be asymptomatic or present as a painless swelling. This report describes the case of a 13-year-old girl with AFO in the right posterior mandibular region, treated conservatively with enucleation and curettage.
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One hundred and twenty-seven cases of histologically confirmed odontogenic tumors were retrieved from a total of 5,289 oral and maxillary lesions diagnosed at the Division of Oral Pathology, Federal University of Rio Grande do Norte, during a period of 30 years (l970-l999). The most common histological diagnosis was odontoma (50.40%), followed by ameloblastoma (30.70%). The prevalence of odontogenic tumors was greater in females and the peak incidence occurred in the second and third decades of life. The main anatomical location was the mandible, and no malignant tumors were found.
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Reports about the frequency of odontogenic tumors are scarce, and diagnostic criteria used in the reports are not uniform. This article presents the results of a retrospective study of odontogenic tumors recorded in four services of diagnostic pathology in Mexico City (two dental schools, one cancer hospital, and one private oral pathology service). The final diagnosis in each case was based on the 1992 histologic criteria of the World Health Organization. The frequency of odontogenic tumors, expressed as a percent of all oral and maxillofacial specimens, ranged from 0.8% in the cancer hospital (0.02% of all biopsies) to 3.7% in the private oral pathology service. The frequency was identical for the two dental schools (2.5%). We found a total of 349 odontogenic tumors; of these, 345 were benign (98.8%), and 4 (1.1%) were malignant (3 were primary intraosseous carcinomas and 1 was a malignant ameloblastoma). The most frequently occurring tumors were odontoma (34.6%), ameloblastoma (23.7%), myxoma (17.7%), adenomatoid odontogenic tumor (7.1%), and calcifying odontogenic cyst (6.8%). Although relatively rare, odontogenic tumors are still an important cause of extensive surgical procedures in Mexico.
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To retrospectively document the pattern of occurrence of odontogenic tumours in Tanzania over fifteen years. The histologic types, site, age and sex distribution of odontogenic tumours in Tanzania from 1982 to 1997 were reviewed. Records of patients who presented to the four referral centres in Tanzania and who had histologically proven oral tumours and tumour-like conditions were examined. Odontogenic tumours comprised about 12.2% of all oral tumours and tumour-like conditions. The majority of odontogenic tumours (55.3%) were seen in patients below 30 years of age and they more commonly affected the mandible than maxilla. Ameloblastoma was the most commonly seen odontogenic tumour (73.7%), followed by odontogenic myxoma (10.3%). The site, sex, and histologic distribution of ameloblastoma did not differ from other African studies. Over 50% of patients with ameloblastoma presented to hospital late (after three or more years). In order to improve on the treatment outcome, the need for early detection and referral of patients by medical personnel and dentists is stressed.
Article
The term unicystic ameloblastoma refers to those cystic lesions that show clinical, radiographic, or gross features of a jaw cyst, but on histologic examination show a typical ameloblastomatous epithelium lining part of the cyst cavity, with or without luminal and/or mural tumor growth. To ascertain the clinicomorphologic spectrum and biologic behavior of this tumor group, the clinicopathologic features of 33 unicystic ameloblastomas from Chinese patients were studied. This series represents approximately 19% of all cases of ameloblastoma accessioned in the authors' hospital during a 15-year period. Twenty-one patients were male and 12 were female, for a total of 33 patients. The age at diagnosis ranged from 8 to 60 years (mean, 25.3 yrs) and peaked at the second and third decades (70%). Thirty tumors (91%) occurred in the mandible and three in the maxilla. Of the 29 patients with a radiographic record, an expansive unilocular radiolucency was seen in 22 cases, and was multilocular in seven cases. Microscopically, all tumors demonstrated a generally monocystic growth pattern. Eight tumors were simple cystic, 10 comprised intraluminal tumor nodules, and the remaining 15 had a conspicuous component of infiltrative tumor islands in the cyst capsule. The cystic tumor linings invariably showed, at least in part, a typical ameloblastomatous pattern that was often accompanied by epithelial areas of various histologic appearance. Follow up of 29 patients revealed no recurrence in less than 4 years of follow up, but did reveal a 35% recurrence rate at more than 4 years of follow up. The average interval to recurrence was approximately 7 years. Recurrence also appeared to relate to histologic subtypes of unicystic ameloblastoma, with those invading the fibrous wall having a rate of 35.7%, but other types having a rate of 6.7%. Despite the fact that unicystic ameloblastoma may, in general, compare favorably with its solid or multicystic counterpart in terms of clinical behavior and response to treatment, the subsets of the maxillary lesions or tumors containing invading islands in the fibrous wall could have a high risk of recurrence. Furthermore, recurrence of unicystic ameloblastoma may be long delayed, and a long-term postoperative follow up is essential to the proper management of these patients.
Article
Background Clear cell odontogenic carcinoma (CCOC), which has been described within the past 2 decades, is a rare odontogenic tumor that tends to occur in the mandible of older adults, with a predilection for women. It is potentially aggressive and capable of multiple local recurrences and locoregional and distant metastases.Objectives To report the clinicopathologic findings and follow-up of a case of CCOC and to review the literature.Design Case report and literature review.Main Outcome Measurements Findings from histologic analysis, immunohistochemistry, and electron microscopy.Results An 81-year-old woman experienced 3 locoregional recurrences within 21 months of initial therapy. She is presently disease free, 4.5 years after initial resection, having received multiple resections and adjuvant radiotherapy.Conclusions The diagnosis of CCOC must be considered in the differential diagnosis of jaw tumors with a clear cell component. For these tumors, resection with negative margins is the treatment of choice because more conservative surgery (eg, curettage) inevitably results in recurrence and/or metastasis. Adjuvant radiotherapy is a rational option for tumors that have eroded cortex.
Article
From a total of 54,534 oral biopsy specimens, 706 (1.3%) odontogenic tumors were retrieved and reviewed. Odontomas comprised more than 65% of the odontogenic tumors, ameloblastomas about 10%, and the remaining six categories of odontogenic tumors accounted for approximately 25% of the lesions. The distribution by age, sex, and location of these tumors generally supported the data from other previously reported cases. A possible variant of the calcifying epithelial odontogenic tumor was described, and instances of two granular cell ameloblastic fibromas were reported. The myxomas as a group were characterized histologically more by residual bony trabeculae than by the presence of odontogenic rests. Because the clinical, histological, and behavioral features of the ameloblastic fibroma and ameloblastic fibro-odontoma were similar, these lesions were considered to be essentially the same. From limited follow-up information, the ameloblastoma was the only lesion that recurred. With the exception of one ameloblastoma found in the lung, no malignant odontogenic tumors were encountered.
Five cases of squamous odontogenic tumorlike proliferations occurring in the walls of odontogenic cysts are presented. These lesions showed no more aggressive potential than the cysts, if taken alone, in which they occurred. The lesions showed no tendency to develop into solid tumors and, on the basis of this limited series of cases, conservative surgery appears to be the treatment of choice.
All the 49 jaw ameloblastomas reported to the Swedish Cancer Registry during the period 1958--1971 were re-examined, using the histopathologic criteria of odontogenic tumors adopted by WHO. Thirty-one cases (63.6%) fulfilled the criteria of simple ameloblastoma, whereas 12 cases were found to be other benign lesions and 6 to be malignant tumors other than ameloblastoma. The relationship between simple ameloblastoma, malignant ameloblastoma and other epithelial jaw tumors is discussed.
The patients reported on here were seen and treated in the Department of Oral Surgery and Pathology, Division of Dentistry, Lagos University Teaching Hospital, between September, 1969, and September, 1974. Materials for histopathologic examination came from tissues removed at biopsy or surgical excision of the lesions. Out of a total of about 200 benign and malignant lesions of the oral cavity seen during the 5-year period (all cysts excluded), twenty-nine (15 per cent) were tumors arising from the odontogenic tissues as follows: ameloblastoma, nineteen; ameloblastic fibroma, two; adrenomatoid odontogenic tumor, two; ameloblastic fibro-odontoma, one; odontoma, two; cementoma, two; and calcifying odontogenic cyst, one. The author had the privilege of seeing all the patients and examining all the biopsy and surgical specimens.
One hundred forty-nine cases of odontoma were reviewed: sixty-five cases were accepted from the literature, and eighty-four additional cases were included from the files of the Pathology Department of the Emory University School of Dentistry. The cases were combined and analyzed together. Odontomas are most often diagnosed in the second decade of life. Sixty-five per cent of all odontomas occur in the maxilla. Compound odontomas are more common in the anterior maxilla, whereas complex odontomas occur more frequently in the posterior jaws. A slight predominance in males was seen. The most common presenting symptom was an impacted tooth with retention of deciduous teeth.
Article
This article introduces the revised World Health Organization (WHO) classification of odontogenic tumors and jaw cysts and certain bone lesions that either are peculiar to the jaws or have distinctive features in that location. The new and revised classification is compared with the previous version, the reasons for the changes are outlined, and reference is made to a number of newly characterized lesions that have been included.
Article
This study reviews and analyzes the clinical, radiographic, and histomorphologic features of the 215 cases of central calcifying odontogenic cyst (CCOC) reported in the literature. Based on the present information, a clinicopathologic classification of calcifying odontogenic cyst is proposed. The CCOC is also compared with its peripheral counterpart and the differences discussed.
Article
Reports on the incidence of odontogenic tumours are infrequent with only a limited number of series having appeared in the literature. In this paper, the results of a multicentre retrospective study on the histologic types and relative frequencies of odontogenic tumours in Turkey are presented. The results indicated that the most frequent histologic type was ameloblastoma (36.5 per cent) and the area at greatest risk for the development of odontogenic tumours was the mandibular molar region. A Table showing the most likely type of tumour by location is also presented.
A total of 351 odontomas were retrieved and analyzed from 53,824 submitted specimens. The majority (53.6%) were diagnosed in the second decade of life; the most common location was the anterior portion of the maxilla (33.9%), but there was no overall predilection for the maxilla. An associated unerupted tooth was present in at least 47.6% of the cases. Dentigerous cysts were diagnosed in conjunction with 27.6% of the odontomas, and a calcifying and keratinizing odontogenic cyst was seen in 0.9% of the cases.
Article
A clinicopathological study of 57 unicystic ameloblastomas has been undertaken, which represents 15% of all cases of ameloblastoma accessioned in our department over a 30-yr period. Of the cases where gender was recorded: 30 were male and 23 female. The majority of patients were black (51 cases) and most occurred in the mandible (52). This distribution conforms to that of solid and multicystic ameloblastomas. The mean age at diagnosis was 23.8 years (S.D. 14.9) which is significantly younger than for the conventional counterpart (p less than 0.1%). The lesions were classified histologically into 3 groups: Group 1 (42%) cyst lined by a variable often non-descript epithelium; Group 2 (9%) cyst showing intraluminal plexiform proliferation of epithelium; Group 3 (49%) cyst with invasion of epithelium into the cyst wall in either follicular or plexiform patterns. While Group 1 and 2 lesions may be treated by enucleation, Group 3 lesions should be treated aggressively as for conventional ameloblastomas. The objectives of correct histological diagnosis, subclassification and appropriate therapy are best achieved by enucleation biopsy. There is little evidence to support origin from pre-existing odontogenic cysts.
Article
A total of 114 tumours of the jawbones was confirmed in a survey of 204,583 surgical specimens in Chinese in the University Department of Pathology, Hong Kong from 1963-1982. Odontogenic tumours totalled 82 of which 62 per cent were ameloblastomas. Thus, odontogenic tumours, in particular ameloblastomas, are relatively common in Chinese. In the 51 cases of ameloblastoma, the mean age at presentation in females was significantly younger than in males. Pathological analysis of the ameloblastomas showed the following: (1) connection of tumour epithelium with oral mucosal epithelium suggests a better prognosis; (2) basaloid pattern in the tumour may prognostically indicate a more aggressive biological behaviour; (3) neoplastic infiltration of the grossly normal bone surrounding the tumour mass was frequent; (4) ameloblastomas not uncommonly contained cysts lined by innocuous-looking epithelium; (5) a significant proportion of ameloblastomas appeared grossly as thin-walled unilocular cysts. The implications of these findings in the diagnosis and treatment of ameloblastoma are emphasized.
Article
This study shows that there are 288 different types of rare and common lesions of the oral cavity, 3% of which are life-endangering, and that dentists are concerned with the total care of the oral cavity.
Available literature on ameloblastoma of the jaw was reviewed, including publications from 1960 to 1993, and compared to the latest larger review, published by Small and Waldron in 1955. The average age of patients with ameloblastoma is 36 years. In developing countries ameloblastomas occur in younger patients. Men and women are equally affected. Women are 4 years younger than men when ameloblastomas first occur, and the tumours appear to be larger in females. Dominant clinical symptoms such as painless swelling and slow growth are non-characteristic. The ratio of ameloblastoma of the mandible to maxilla is 5 to 1. Ameloblastomas of the mandible occur 12 years earlier than those of the maxilla. Ameloblastomas occur most frequently in the molar region of the mandible. In Blacks, ameloblastomas occur more frequently in the anterior region of the jaws. Radiologically, 50% of ameloblastomas appear as multilocular radiolucent lesions with sharp delineation. Histologically, one-third are plexiform, one-third follicular; other variants such as acanthomatous ameloblastoma occur in older patients. Two percent of ameloblastomas are peripheral tumours. Unicystic ameloblastomas occurring in younger patients have been found in 6%. Detailed data on 345 patients with ameloblastoma were evaluated for clarification of therapeutic approaches. Chemotherapy and radiation seem to be contraindicated. Ameloblastomas of the maxilla should be treated as radically as possible, ameloblastomas of the mandible should also be treated radically. However, ameloblastomas which radiologically appear as unilocular lesions may be treated conservatively (enucleation, curettage), whenever all areas of the cystic lumen are controllable intraoperatively. Unicystic ameloblastomas occurring in patients 15 years younger than those with multisystic ameloblastoma may be treated conservatively except in cases with invasion of epithelium into the cyst wall. Different recurrence rates have been found for histological variants of the ameloblastoma. Follicular ameloblastomas appear to recur more often than the plexiform type. Unicystic ameloblastomas reveal lower recurrence rates than "non-unicystic" ameloblastomas. The peripheral type of ameloblastoma may be excised, since conservative therapy results in low recurrence rates. Postoperative follow-up is most important in the therapy of ameloblastoma, because more than 50% of all recurrences occur within 5 years postoperatively.
The central odontogenic fibroma is a rare benign neoplasm that is considered to be derived from mesenchymal dental tissue. This study reviews and analyzes the radiologic features of 51 cases (5 new cases and 46 from the literature). Central odontogenic fibroma appears in both the mandible and maxilla (55% and 45%, respectively). In the maxilla it has a tendency to involve the anterior area, whereas in the mandible the molar and premolar areas are the most prevalent sites. The majority of central odontogenic fibromas are unilocular radiolucent lesions with well-defined borders, but they may also appear as multilocular lesions and in rare instances may exhibit a mixed radiolucent/radiopaque appearance with poorly defined or diffused borders. The great variability in radiologic appearance of the central odontogenic fibroma means that it should be considered in the differential diagnosis of all radiolucencies found in the jaws.
This article includes five new cases of benign cementoblastoma. The study includes a review on 66 previously published cases that we consider to be bonafide cases. It is considered that benign cementoblastoma continues to be an infrequent entity that particularly affects young patients under the age of 30. The sex distribution shows a slight tendency for being more common in females. The most frequently effected area is the mandibular molar-premolar region. Pain, expansion and, radiographic radiopacity surrounded by a peripheral radiolucent halo are the most striking features. Treatment and prognosis are also discussed. Histopathologic conditions and factors to be considered with respect to differential diagnosis conclude the report.
The diagnoses of 40,000 consecutively accessioned oral biopsies from the Oral Pathology Diagnostic Service, University of Western Ontario, London, Canada, were reviewed. All odontogenic neoplasm, neoplasm-like lesions (tumors), and true cysts of the oral tissues and jaws were listed. Clinical data were reviewed, and microscopic diagnoses were confirmed for cases in which diagnoses were ambiguous. Records of all cases were examined to identify distant referrals that were not representative of the study population. Of a total of 445 (1.11%) odontogenic tumors, 392 (0.98%) were lesions from patients in the usual local drawing area of the biopsy service; 53 were referred from distant centers. From the local population, odontomas were by far the most common tumor (51.53%) followed by ameloblastomas (13.52%) and peripheral odontogenic fibromas (8.93%). Locally, radicular (periapical) cysts were the most common odontogenic cyst (65.15%) followed by the dentigerous cyst (24.08%) and the odontogenic keratocyst (4.88%). The most common nonodontogenic cyst was the nasopalatine duct cyst that accounted for 73.43% of this subset of cysts. Surprisingly few studies of this type are available, especially for odontogenic tumors. These data are important to assess geographic differences in the incidence of lesions and to allow clinicians to make realistic judgments in counseling patients before biopsy about the probability of diagnosis and risks associated with nonspecific clinical or radiographic lesions.
Article
The squamous odontogenic tumor is almost exclusively an intraosseous lesion of the jaw bones. Only 1 extraosseous variant has been reported. The tumor is histologically benign, with only occasional recurrences after surgical removal. Malignant alteration is unknown, but the lesion must be distinguished from intraosseous squamous cell carcinomas.
Article
The dental follicle is radiographically and histologically observed in association with unerupted or impacted teeth. However, this normal tissue structure is often confused with odontogenic tumors by pathologists with limited experience in evaluating jaw lesions. This study was designed to evaluate the incidence and possible reasons for incorrect interpretation of dental follicles. From 1970 to 1988, 847 dental follicles and/or dental papillas from 663 patients were submitted to the Armed Forces Institute of Pathology (AFIP) by medical pathologists seeking diagnostic consultation. Nearly 84% of patients were in the second and third decades of life. The male to female ratio was 1.4:1.0. Over 70% of specimens were obtained from around impacted third molar teeth. Fifty-three percent of specimens were correctly interpreted by the contributing pathologists. Only a descriptive interpretation was given for 17%, no diagnosis was made in 10%, and 20% were incorrectly diagnosed. In descending order, the most frequent incorrect diagnoses were odontogenic cyst, odontogenic myxoma, odontogenic fibroma, ameloblastic fibroma, odontoma, and ameloblastoma. Dental papillas were most frequently misdiagnosed as odontogenic myxomas. The histologic features and diagnostic pitfalls are discussed, as well as the need to consider the clinical, radiographic, and microscopic features in arriving at a final diagnosis.
Article
Two hundred and eighty-nine cases of odontogenic tumors that accumulated in the files of the biopsy service of the Lagos University Teaching Hospital during a period of 21 years were analysed and categorised according to the most recent WHO classification of odontogenic tumors. Odontogenic tumors constituted 19% of all oral/jaw tumors and tumor-like lesions. Ameloblastoma, which accounted for 58.5% of odontogenic tumors in the series, was the most common, and showed a predilection for males and the posterior mandible. 94.8% of odontogenic tumors were benign, while malignant odontogenic tumors accounted for 5.2%. Odontogenic carcinoma was the most prevalent malignant odontogenic tumor; it showed a prediction for the mandible and occurred at a mean age of 37 years.
Article
Surgical pathologists are cautioned against the misinterpretation of immature dental tissues (dental papillae and follicles) and dental pulp as odontogenic tumors, especially odontogenic myxomas and fibromas. The close histologic similarity of the immature tissues to tumors may require a clinical-radiologic correlation with the histopathologic specimen in order to distinguish the locally aggressive tumors from innocuous dental tissues.
Article
To review the histopathological and clinical data on odontogenic tumours. A retrospective study of 148 odontogenic tumours seen over a 10 year period. Department of Oral and Maxillofacial Surgery at Harare Central Hospital, Harare, Zimbabwe. Histopathologic records of patients with odontogenic tumour. Age and sex distribution of the various tumours. Frequency distribution of tumours. From a total of 1723 biopsies over a 10 year period, 8.6pc were tumours of odontogenic origin. Ameloblastoma comprised 79.1pc of the odontogenic tumours. Odontogenic tumours are uncommon lesions,8,6pc. Ameloblastoma is the commonest odontogenic tumour, 79.1pc. The only malignant odontogenic tumour noted was ameloblastic fibro-sarcoma, 0.7pc.
Article
True neoplasms are rarely localised to the periodontium. However, early recognition and diagnosis of neoplastic lesions resides within the realm of responsibility of the dentist. In recent years, a number of odontogenic tumors has been described characterized by an occurrence on the gingiva or in the intrabony part of the periodontium. One such neoplasm, the squamous odontogenic tumor (SOT) originally described 20 years ago is now a well-recognized entity localized to the periodontium, be it in the periodontal ligament or in the gingivae. A review of 36 acceptable cases of this tumor published sofar, forms the basis of the present paper.
Article
Based on a world-wide literature survey of published cases of "mixed odontogenic tumours" (ameloblastic fibroma, fibrodentinoma and fibro-odontoma) and complex/compound odontomas (including 134 own cases of odontomas) the authors present data showing the complex nature of these lesions. The authors suggest the following work hypothesis regarding the pathogenesis and relationship between the "mixed odontogenic tumours" and the odontomas. The tumours develop along two separate lines: (I) the neoplastic line comprising only one tumour, the ameloblastic fibroma (AF) and the closely related ameloblastic fibrodentinoma (AFD). (II) The hamartomatous (or the developing complex odontoma (DCO) line comprising: (1) The AF (and AFD). Differences in age and biological behaviour indicate that some AF are true benign neoplasms, whereas others are hamartomas presenting the first stage in the DCO-line. (2) The AF-O represents the second stage of the DCO-line developing into (3) the fully mineralized complex odontoma. Lastly, the authors suggest that the compound odontoma should be considered not as an alternative final stage to the complex odontoma but rather as a malformation (with a high degree of histomorphological differentiation) pathogenetically closely related to the process producing hyperodontia, "multiple schizodontia" or locally conditioned hyperactivity of the dental lamina.
Article
To establish the incidence of odontogenic tumours in Nigeria we present our experience during the 15-year period 1980-94. Retrospective review of histopathological specimens and case notes. Teaching hospital, Nigeria. 128 Patients with histologically confirmed odontogenic tumours out of a total of 415 with tumours of the mouth and jaw. Incidence, treatment, and recurrence rate. Ameloblastoma (n = 21, 16%) and adenomatoid tumour (n = 16, 13%). Patients' ages ranged from 8 to 75 years (mean 33 for ameloblastoma, 31 for fibromyxoma, and 22 for adenomatoid tumour). The corresponding male:female ratios were 3:2, 2:3, and 1:1, and maxilla:mandible ratios 1:9, 1.1:1, and 2:1. The more radical the resection of ameloblastomas the less likely were they to recur. Further research is required to explain the high incidence of odontogenic tumours in Nigeria, particularly ameloblastomas.
Article
To analyse critically the clinical and radiological features of odontogenic myxoma. The clinical features of 164 cases of odontogenic myxoma (two new and 162 from the literature) and the radiological features of 96 cases (two new and 94 from the literature) were analysed. Most of the tumors (75%) were diagnosed in the 2nd to 4th decades. The male to female ratio was 1:1.5. Tumors were located in the mandible in two-thirds and in the maxilla one-third of cases. A multilocular appearance was observed in 55% and unilocular in 36%; 9% were not loculated. There was a statistically significant correlation (P < 0.000) between the size of the lesion and its locularity with the larger lesions more likely to be multilocular. Only 5% of the tumors were associated with an unerupted tooth. Odontogenic myxoma has a variable clinical and radiological appearance and it should be considered in the differential diagnosis of radiolucent and mixed radiolucent-radiopaque lesions of both jaws in all age groups.
Article
An odontoma refers to any tumor of odontogenic origin. Three distinct types of odontomas have been distinguished in the dental literature: complex, compound, and ameloblastic fibro-odontoma. Odontomas are usually associated with overly retained primary and unerupted permanent teeth. The exact etiology of odontomas is unknown, but local trauma, infection, inheritance, and genetic mutation have been postulated as possible causes of odontomas. Studies have found that males are more likely than females to have odontomas, with most frequent occurrence in the second decade of life. One hundred four biopsy reports with a diagnosis of odontoma were analyzed for age, race, gender, location, pre-operative diagnosis, and postoperative laboratory findings. Most odontomas occurred in the 11-20 age group, with Caucasians predominating. The majority were located in the maxilla, and 85 percent were correctly diagnosed clinically by the attending dentist prior to confirmation by histologic pathology reports of the biopsy specimens. The vast majority were compound odontomas (64.4%) with complex odontomas comprising 31.0% of the total lesions. No ameloblastic fibro-odontomas were diagnosed.
Article
Based on a world-wide literature survey of 193 published cases of unicystic ameloblastomas (UA), data have been produced allowing the presentation of a revised concept of this much debated lesion. UA is a variant of the solid or multicystic ameloblastoma. Radiographically, the unilocular pattern is more common that the multilocular, especially in cases associated with tooth impaction. However, it is stressed that although the lesion is pathomorphologically unicystic, it will far from always produce a unilocular radiolucency. The mean age at the time of diagnosis of UA is closely related to an association with an impacted tooth. Almost 20 years separate the mean age of the 'dentigerous' variant from the 'non-dentigerous' (16.5 years versus 35.2 years) The male:female ratio for the 'dentigerous' type is 1.5:1, but for the 'non-dentigerous' type it is reversed (1:1.8). Location favours greatly the mandible (mandible to maxilla = 3 to 13:1). Between 50 and 80% of cases are associated with tooth impaction, the mandibular third molar being most often involved. The 'dentigerous' type occurs on average 8 years earlier than the 'non-dentigerious' variant. The mean age for unilocular, impaction-associated UAs is 22 years, whereas the mean age for the multilocular lesion unrelated to an impacted tooth is 33 years. Histologically, the minimum criterion for diagnosing a lesion as UA is the demonstration of a single cystic sac lined by odontogenic (ameloblastomatous) epithelium often seen only in focal areas. This simple type of UA (according to the authors' modification of the classification by Ackermann et al. (Journal of Oral Pathology 1988; 17:541-546)), is one of four UA subtypes, the others being (1) simple with intralumenal proliferations; (2) simple with both intralumenal and intramural proliferations; and (3) simple with intramural proliferations only. All four subtypes occur in both the 'dentigerous' and 'non-dentigerous' variants. The simple subtype with and without intralumenal proliferations may be treated conservatively (enucleation), whereas subtypes showing intramural growths must be treated radically, i.e. as a solid or multicystic ameloblastoma. Finally, the authors disclose areas and issues pertaining to UA that still need to be addressed.
Article
Seven hundred fifty-nine cases of odontogenic tumors retrieved from the files of College of Stomatology, West China University of Medical Sciences were classified according to the World Health Organization's Histological Classification of Odontogenic Tumors and compared with similar reports from other countries. Among these cases, 93.9% of the tumors were benign and 6.1% were malignant. Ameloblastomas predominated (58.6%) with a predilection for the mandible, while odontomas, generally regarded as the most frequent odontogenic tumor in North America, only accounted for 6.7%, the fourth most common tumor in this series. The mandible and the maxilla were divided into eight anatomic regions, and the distribution of each odontogenic tumor type amongst these regions was recorded. The relative incidence of each tumor type, patient age and gender were also compared with data from other selected large series. Geographic differences were noted in the relative incidence of ameloblastoma, odontoma and malignant odontogenic tumors among the Chinese/African, North American and Turkish/German groups. Ameloblastoma and malignant odontogenic tumors are not considered rare in a Chinese population.
Article
The present profile of the adenomatoid odontogenic tumour represents an update based on data collected from 1991 onwards. Our present knowledge discloses the AOT being a benign (hamartomatous), slow growing lesion which occurs in several intraosseous (follicular (F) and extrafollicular (EF)) and one peripheral variant all having identical histology. The F and EF variants account for 96 per cent of all AOT's of which 71 per cent are F variants alone. F and EF variants together are more commonly found in the maxilla than in the mandible with a ratio of 2.1:1. Age distribution shows that more than two thirds are diagnosed in the second decade of life and more than half of the cases occur within the teens (13-19 years of age). The female:male ratio for all age groups and AOT variants together is 1.9:1. The marked female predominance (around 3:1) among certain Asian populations needs further clarification. The distribution of unerupted permanent teeth found in association with the F variant shows that all four canines account for 59 per cent and the maxillary canines alone for 40 per cent. Recent findings strongly indicate the AOT is derived from the complex system of dental laminae or its remnants. Occurrence of areas of CEOT-like tissue in an otherwise "classic" AOT should be considered a normal feature within the continuous histomorphological spectrum of AOT. Immunohistochemical and ultrastructural findings have revealed that the eosinophilic deposits or "tumour-droplets" most probably represent some form of enamel matrix.
Article
Malignant epithelial odontogenic tumors are very rare. They may arise from the epithelial components of the odontogenic apparatus. The rests of Malassez, the reduced enamel epithelium surrounding the crown of an impacted tooth, the rests of Serres in the gingiva, and the linings of odontogenic cysts represent the precursor cells for malignant transformation. Because metastatic carcinoma is the most common malignancy of the jaws, the diagnosis of a primary intraosseous carcinoma must always be made to the exclusion of metastatic disease. Odontogenic carcinomas include malignant (metastasizing) ameloblastoma, ameloblastic carcinoma, primary intraosseous squamous cell carcinoma, clear cell odontogenic carcinoma, and malignant epithelial ghost cell tumor. There are specific histopathologic features that support the diagnosis of a primary carcinoma of odontogenic epithelium which are presented in this article. Immunohistochemical (IHC) staining is important for distinguishing clear cell odontogenic carcinoma from metastatic renal cell tumors, yet IHC stains are not particularly helpful for other lesions in this group-all of which exhibit low molecular weight cytokeratin positivity. Aggressive growth and nodal and distant metastases occur with all of these entities.
Article
The odontogenic myxoma is an uncommon tumor that has the potential for extensive bony destruction, extension into surrounding structures, and a relatively high recurrence rate. Treatment often requires bone resection. The bland histologic features of a monotonous proliferation of a loose, mesenchymal fibrous tissue that lacks atypia may easily lead to a misdiagnosis. The primitive dental pulp, the dental papilla, and the tooth follicle are histologically similar to myxoma. These soft tissue fragments often separate from extracted developing teeth that are submitted to the pathologist and may easily be misinterpreted as an odontogenic myxoma. The pathologist must have good clinical and radiographic correlation to avoid a misdiagnosis and to prevent unnecessary additional surgery.
Article
The odontogenic fibroma is a rare tumor that has generated controversy, perhaps disproportionately to its importance in the family of odontogenic tumors. The clinical and radiographic features are well documented but the histologic aspects have generated controversy. The behavior is benign, and published accounts indicate a low recurrence rate following treatment by curettage. The tumor recognized by the World Health Organization (WHO) is the legitimate odontogenic fibroma. Histologic variants include the granular cell type and the hybrid odontogenic fibroma giant cell-like tumor. Although the extraosseous "peripheral" odontogenic fibroma presents as a gingival enlargement clinically indistinguishable from other gingival lesions, its histomorphology is similar to the central tumor. A normal dental follicle around the crown of an unerupted tooth may histologically mimic the odontogenic fibroma and other odontogenic tumors.
Article
The present profile of the calcifying epithelial odontogenic tumour (CEOT) is based on a literature survey of 181 published tumour cases. The CEOT is a benign, though occasional locally invasive, slow-growing neoplasm occurring as intraosseous (94%) and extraosseous (6%) variants. The intraosseous type appears radiographically as an irregular, uni- or multilocular radiolucent area containing radiopaque masses which increases in size and opacity with time. Some 60% of intraosseous CEOT are associated with an unerupted tooth (or odontoma). CEOT shows a relative frequency of 1-2%. The extraosseous variant is diagnosed slightly earlier (mean age 34.4 years) than the intraosseous type (mean age 38.9 years). Both variants have an almost 1:1 gender ratio. The intraosseous CEOT shows a maxilla:mandible site ratio of 1:2 and are mainly located in the premolar/molar region. The present authors present evidence that the CEOT originates from the complex system of dental laminae or remnants thereof. Histologically, the CEOT is characterized by the occurrence of sheets, nests and masses of polyhedral, eosinophilic epithelial cells which may show cellular abnormalities including giant cell formation and nuclear pleomorphism. Some cells increase in size and produce a homogeneous, eosinophilic, 'amyloid-like' substance which may become calcified and which may be liberated as the cells break down. The true nature of the amyloid-like material is still unresolved. Histological variants including CEOT with cementum-like components, clear-cell CEOT (15 cases reported so far), CEOT-containing Langerhans' cells, combined epithelial odontogenic tumour (CEOT/AOT) and CEOT with myoepithelial cells are discussed in detail. In view of the relatively indolent biological behaviour of the CEOT, mutilating procedures, such as wide resection or hemisection of the mandible, seem unwarranted. Enucleation with a margin of macroscopically normal tissue is, therefore, the recommended treatment for CEOT involving the mandible. Maxillary CEOT should, however, be treated more aggressively, as they tend to grow more rapidly and do not usually remain well confined. Generally, recurrences are rare. Five years is considered the absolute minimum follow-up period. The survey has revealed only one well-documented case of a mandibular CEOT in a 75-year-old man showing features of malignancy.
Article
The frequencies of oro-maxillo-facial tumors, by type, seen at the Guangxi Medical College Hospital were surveyed in order to compare different regions of the People's Republic of China. Computer analysis was performed on data for all oro-maxillo-facial tumors, as confirmed by the hospital between 1957 and 1987, inclusive. The results were then used in a comparative study with those of five other medical colleges. Among a total of 4,052 cases, there were 1,593 benign tumors, 2,049 malignant tumors and 410 unknown tumors. Tumors derived from the epithelium were the most common type (42.0% of the total), whereas in the other five medical colleges the mean corresponding proportion was 27.8%, the difference being significant (p < 0.05). Epithelial tumors were also the most common type of malignant tumor (70.5% of the total), whereas the corresponding proportion reported by the other five institutions was 60.6%, which was also significantly different (p < 0.05). The proportion of malignant tumors among the total was more than 50.6%, which was higher than that reported by the other five colleges. This study shows that epithelium-derived tumors and malignant tumors were encountered more frequently at Guangxi Medical College than at the other five medical colleges in China.
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One hundred and twenty-seven cases of histologically confirmed odontogenic tumors were retrieved from a total of 5,289 oral and maxillary lesions diagnosed at the Division of Oral Pathology, Federal University of Rio Grande do Norte, during a period of 30 years (1970-1999). The most common histological diagnosis was odontoma (50.40%), followed by ameloblastoma (30.70%). The prevalence of odontogenic tumors was greater in females and the peak incidence occurred in the second and third decades of life. The main anatomical location was the mandible, and no malignant tumors were found.