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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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Cystic squamous odontogenic tumor. a Panoramic radiograph, b and c solid-cystic proliferation of mature squamous epithelium (Hematoxylin–Eosin, ×40)
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Fig3: Cystic squamous odontogenic tumor. a Panoramic radiograph, b and c solid-cystic proliferation of mature squamous epithelium (Hematoxylin–Eosin, ×40)

Mentions: During routine dental treatment, a well-defined, unilocular radiolucency enclosing the root of a horizontally impacted right lower third molar was found in a 46-year-old woman (Fig. 3a). A solid mass was excised along with the tooth. On microscopic examination, there were interconnected budding islands of bland squamous epithelium reminiscent of pseudoepitheliomatous hyperplasia, in addition to large cystic spaces containing desquamated keratin (Fig. 3b, c). The cyst lining had neither basal palisading nor corrugated parakeratin layer and immunostaining for Bcl-2 was negative. After a search of the relevant literature, the most likely diagnosis at this time was cystic squamous odontogenic tumor. A few tumor nests were found in the resection margins, but there has been no sign of recurrence in the ensuing 3 years.Fig. 3


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

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

Cystic squamous odontogenic tumor. a Panoramic radiograph, b and c solid-cystic proliferation of mature squamous epithelium (Hematoxylin–Eosin, ×40)
© Copyright Policy
Related In: Results  -  Collection

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

Fig3: Cystic squamous odontogenic tumor. a Panoramic radiograph, b and c solid-cystic proliferation of mature squamous epithelium (Hematoxylin–Eosin, ×40)
Mentions: During routine dental treatment, a well-defined, unilocular radiolucency enclosing the root of a horizontally impacted right lower third molar was found in a 46-year-old woman (Fig. 3a). A solid mass was excised along with the tooth. On microscopic examination, there were interconnected budding islands of bland squamous epithelium reminiscent of pseudoepitheliomatous hyperplasia, in addition to large cystic spaces containing desquamated keratin (Fig. 3b, c). The cyst lining had neither basal palisading nor corrugated parakeratin layer and immunostaining for Bcl-2 was negative. After a search of the relevant literature, the most likely diagnosis at this time was cystic squamous odontogenic tumor. A few tumor nests were found in the resection margins, but there has been no sign of recurrence in the ensuing 3 years.Fig. 3

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