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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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Primary intraosseous squamous cell carcinoma. a Panoramic radiograph taken in 2006, b panoramic radiograph (2008) showing eruptive movement of third molar with osteolytic change, c well-differentiated squamous cell carcinoma (Hematoxylin–Eosin, ×200), d p53 overexpression (ABC method, ×200)
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Fig6: Primary intraosseous squamous cell carcinoma. a Panoramic radiograph taken in 2006, b panoramic radiograph (2008) showing eruptive movement of third molar with osteolytic change, c well-differentiated squamous cell carcinoma (Hematoxylin–Eosin, ×200), d p53 overexpression (ABC method, ×200)

Mentions: The patient, a 65-year-old woman, complained of a white surface speckling on the left retromolar alveolar mucosa. There was no significant radiographic change around a horizontally impacted third molar (Fig. 6a). Within 2 years, she became aware of an eruption of the tooth. Radiographically, periradicular rarefaction with an ill-defined inferior margin extended deeply to the level of mandibular canal (Fig. 6b). Soft-tissues associated with the extracted molar revealed microscopic features of a well-differentiated squamous cell carcinoma (Fig. 6c). Tumor cells were mostly immunopositive for Ki-67 and p53 (Fig. 6d). Because the specimen was removed in piecemeal fashion, transition from pericoronal follicular or gingival sulcular epithelium to carcinoma was not observed. The patient was subsequently referred to another hospital for additional treatment.Fig. 6


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

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

Primary intraosseous squamous cell carcinoma. a Panoramic radiograph taken in 2006, b panoramic radiograph (2008) showing eruptive movement of third molar with osteolytic change, c well-differentiated squamous cell carcinoma (Hematoxylin–Eosin, ×200), d p53 overexpression (ABC method, ×200)
© Copyright Policy
Related In: Results  -  Collection

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

Fig6: Primary intraosseous squamous cell carcinoma. a Panoramic radiograph taken in 2006, b panoramic radiograph (2008) showing eruptive movement of third molar with osteolytic change, c well-differentiated squamous cell carcinoma (Hematoxylin–Eosin, ×200), d p53 overexpression (ABC method, ×200)
Mentions: The patient, a 65-year-old woman, complained of a white surface speckling on the left retromolar alveolar mucosa. There was no significant radiographic change around a horizontally impacted third molar (Fig. 6a). Within 2 years, she became aware of an eruption of the tooth. Radiographically, periradicular rarefaction with an ill-defined inferior margin extended deeply to the level of mandibular canal (Fig. 6b). Soft-tissues associated with the extracted molar revealed microscopic features of a well-differentiated squamous cell carcinoma (Fig. 6c). Tumor cells were mostly immunopositive for Ki-67 and p53 (Fig. 6d). Because the specimen was removed in piecemeal fashion, transition from pericoronal follicular or gingival sulcular epithelium to carcinoma was not observed. The patient was subsequently referred to another hospital for additional treatment.Fig. 6

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