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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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Keratocystic odontogenic tumor. a Periapical radiograph, b solid islands of bland squamous epithelium, c basal cell budding (Hematoxylin–Eosin—b ×100, c ×200), d Bcl-2 expression (ABC method, ×200)
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Fig5: Keratocystic odontogenic tumor. a Periapical radiograph, b solid islands of bland squamous epithelium, c basal cell budding (Hematoxylin–Eosin—b ×100, c ×200), d Bcl-2 expression (ABC method, ×200)

Mentions: A 44-year-old man presented with a unilocular, radiolucency with ill-defined margins in the left globulomaxillary area (Fig. 5a). Aspiration yielded no fluid. Under the clinical diagnosis of odontogenic tumor, en block excision was done. Microscopically, an unencapsulated fibrous mass consisted of solid islands of mature squamous epithelium (Fig. 5b). Larger nests displayed thin parakeratinized lining with central slits, but there was no cyst formation. In view of the characteristic budding of basal layer (Fig. 5c) and its Bcl-2 immunoreactivity (Fig. 5d), the original diagnosis of squamous odontogenic tumor was revised to keratocystic odontogenic tumor of solid variant. After 3 years with no recurrence, the patient was lost to follow-up.Fig. 5


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

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

Keratocystic odontogenic tumor. a Periapical radiograph, b solid islands of bland squamous epithelium, c basal cell budding (Hematoxylin–Eosin—b ×100, c ×200), d Bcl-2 expression (ABC method, ×200)
© Copyright Policy
Related In: Results  -  Collection

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

Fig5: Keratocystic odontogenic tumor. a Periapical radiograph, b solid islands of bland squamous epithelium, c basal cell budding (Hematoxylin–Eosin—b ×100, c ×200), d Bcl-2 expression (ABC method, ×200)
Mentions: A 44-year-old man presented with a unilocular, radiolucency with ill-defined margins in the left globulomaxillary area (Fig. 5a). Aspiration yielded no fluid. Under the clinical diagnosis of odontogenic tumor, en block excision was done. Microscopically, an unencapsulated fibrous mass consisted of solid islands of mature squamous epithelium (Fig. 5b). Larger nests displayed thin parakeratinized lining with central slits, but there was no cyst formation. In view of the characteristic budding of basal layer (Fig. 5c) and its Bcl-2 immunoreactivity (Fig. 5d), the original diagnosis of squamous odontogenic tumor was revised to keratocystic odontogenic tumor of solid variant. After 3 years with no recurrence, the patient was lost to follow-up.Fig. 5

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