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Diagnostically challenging epithelial odontogenic tumors: a selective review of 7 jawbone lesions.

Ide F, Mishima K, Saito I, Kusama K - Head Neck Pathol (2009)

Bottom Line: Of two unsuspected keratocystic odontogenic tumors, one depicted deceptive features of pericoronitis, while the other case has long been in our files with the diagnosis of globulomaxillary SOT.Two cases of primary intraosseous squamous cell carcinoma appeared benign clinically and exhibited unexpected findings; an impacted third molar began to erupt in association with the growth of carcinoma and another periradicular carcinoma showed dentinoid formation.Cases selectively reviewed in this article present challenging problems which require clinical and radiographic correlation to avoid potential diagnostic pitfalls.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, Tsurumi University School of Dental Medicine, 2-1-3 Tsurumi, Tsurumi-ku, Yokohama, 230-8501, Japan. ide-f@tsurumi-u.ac.jp

ABSTRACT
Considerable variation in the clinicopathologic presentation of epithelial odontogenic tumors can sometimes be confusing and increase the chance of misdiagnosis. Seven diagnostically challenging jawbone lesions are described. There were 2 cases of mistaken identity in our ameloblastoma file. One unicystic type, initially diagnosed and treated as a lateral periodontal cyst, showed destructive recurrence 6 years postoperatively. The other globulomaxillary lesion was managed under the erroneous diagnosis of adenomatoid odontogenic tumor and recurred 4 times over an 11-year period. This tumor was found in retrospect to be consistent with an adenoid ameloblastoma with dentinoid. The diagnosis of cystic squamous odontogenic tumor (SOT) occurring as a radicular lesion of an impacted lower third molar was one of exclusion. Of two unsuspected keratocystic odontogenic tumors, one depicted deceptive features of pericoronitis, while the other case has long been in our files with the diagnosis of globulomaxillary SOT. Two cases of primary intraosseous squamous cell carcinoma appeared benign clinically and exhibited unexpected findings; an impacted third molar began to erupt in association with the growth of carcinoma and another periradicular carcinoma showed dentinoid formation. Cases selectively reviewed in this article present challenging problems which require clinical and radiographic correlation to avoid potential diagnostic pitfalls.

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Adenoid ameloblastoma with dentinoid. a Periapical radiograph taken in 1988, b primary tumor (1988) showing adenoid spaces and dentinoid, c periapical radiograph (2nd recurrence) taken in 1995, d periapical radiograph (3rd recurrence) taken in 1998, e fourth recurrent (1999) tumor. Asterisk (*) showing sinus cavity, f typical feature of adenoid ameloblastoma with dentinoid (Hematoxylin–Eosin—b ×400, e and f ×100)
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Fig2: Adenoid ameloblastoma with dentinoid. a Periapical radiograph taken in 1988, b primary tumor (1988) showing adenoid spaces and dentinoid, c periapical radiograph (2nd recurrence) taken in 1995, d periapical radiograph (3rd recurrence) taken in 1998, e fourth recurrent (1999) tumor. Asterisk (*) showing sinus cavity, f typical feature of adenoid ameloblastoma with dentinoid (Hematoxylin–Eosin—b ×400, e and f ×100)

Mentions: In June of 1988, a 44-year-old man presented with a heart-shaped, unilocular radiolucency in the left globulomaxillary area involving the apex of the central incisor (Fig. 2a). With a suspicion of odontogenic cyst, enucleation was done and the histologic diagnosis of adenomatoid odontogenic tumor (AOT) was made (Fig. 2b). In November of 1990, the patient re-appeared with an apical radiolucent lesion in the incisor area (Fig. 2c). The second biopsy was also diagnosed as AOT, recurrent. During follow-up, recurrences were noted in February of 1995 (Fig. 2d) and in April of 1998 and again reported to be AOT. In November of 1999, partial maxillectomy was performed, because of the 4th recurrence involving the maxillary sinus (Fig. 2e). Both 1998 and 1999 tumors showed intense immunoreactivity for calretinin. We agree, at least for the present, with the previous reports that the term adenoid ameloblastoma with dentinoid was appropriate (Fig. 2f). No recurrence is evident thereafter.Fig. 2


Diagnostically challenging epithelial odontogenic tumors: a selective review of 7 jawbone lesions.

Ide F, Mishima K, Saito I, Kusama K - Head Neck Pathol (2009)

Adenoid ameloblastoma with dentinoid. a Periapical radiograph taken in 1988, b primary tumor (1988) showing adenoid spaces and dentinoid, c periapical radiograph (2nd recurrence) taken in 1995, d periapical radiograph (3rd recurrence) taken in 1998, e fourth recurrent (1999) tumor. Asterisk (*) showing sinus cavity, f typical feature of adenoid ameloblastoma with dentinoid (Hematoxylin–Eosin—b ×400, e and f ×100)
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Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2807539&req=5

Fig2: Adenoid ameloblastoma with dentinoid. a Periapical radiograph taken in 1988, b primary tumor (1988) showing adenoid spaces and dentinoid, c periapical radiograph (2nd recurrence) taken in 1995, d periapical radiograph (3rd recurrence) taken in 1998, e fourth recurrent (1999) tumor. Asterisk (*) showing sinus cavity, f typical feature of adenoid ameloblastoma with dentinoid (Hematoxylin–Eosin—b ×400, e and f ×100)
Mentions: In June of 1988, a 44-year-old man presented with a heart-shaped, unilocular radiolucency in the left globulomaxillary area involving the apex of the central incisor (Fig. 2a). With a suspicion of odontogenic cyst, enucleation was done and the histologic diagnosis of adenomatoid odontogenic tumor (AOT) was made (Fig. 2b). In November of 1990, the patient re-appeared with an apical radiolucent lesion in the incisor area (Fig. 2c). The second biopsy was also diagnosed as AOT, recurrent. During follow-up, recurrences were noted in February of 1995 (Fig. 2d) and in April of 1998 and again reported to be AOT. In November of 1999, partial maxillectomy was performed, because of the 4th recurrence involving the maxillary sinus (Fig. 2e). Both 1998 and 1999 tumors showed intense immunoreactivity for calretinin. We agree, at least for the present, with the previous reports that the term adenoid ameloblastoma with dentinoid was appropriate (Fig. 2f). No recurrence is evident thereafter.Fig. 2

Bottom Line: Of two unsuspected keratocystic odontogenic tumors, one depicted deceptive features of pericoronitis, while the other case has long been in our files with the diagnosis of globulomaxillary SOT.Two cases of primary intraosseous squamous cell carcinoma appeared benign clinically and exhibited unexpected findings; an impacted third molar began to erupt in association with the growth of carcinoma and another periradicular carcinoma showed dentinoid formation.Cases selectively reviewed in this article present challenging problems which require clinical and radiographic correlation to avoid potential diagnostic pitfalls.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, Tsurumi University School of Dental Medicine, 2-1-3 Tsurumi, Tsurumi-ku, Yokohama, 230-8501, Japan. ide-f@tsurumi-u.ac.jp

ABSTRACT
Considerable variation in the clinicopathologic presentation of epithelial odontogenic tumors can sometimes be confusing and increase the chance of misdiagnosis. Seven diagnostically challenging jawbone lesions are described. There were 2 cases of mistaken identity in our ameloblastoma file. One unicystic type, initially diagnosed and treated as a lateral periodontal cyst, showed destructive recurrence 6 years postoperatively. The other globulomaxillary lesion was managed under the erroneous diagnosis of adenomatoid odontogenic tumor and recurred 4 times over an 11-year period. This tumor was found in retrospect to be consistent with an adenoid ameloblastoma with dentinoid. The diagnosis of cystic squamous odontogenic tumor (SOT) occurring as a radicular lesion of an impacted lower third molar was one of exclusion. Of two unsuspected keratocystic odontogenic tumors, one depicted deceptive features of pericoronitis, while the other case has long been in our files with the diagnosis of globulomaxillary SOT. Two cases of primary intraosseous squamous cell carcinoma appeared benign clinically and exhibited unexpected findings; an impacted third molar began to erupt in association with the growth of carcinoma and another periradicular carcinoma showed dentinoid formation. Cases selectively reviewed in this article present challenging problems which require clinical and radiographic correlation to avoid potential diagnostic pitfalls.

Show MeSH
Related in: MedlinePlus