Immunohistochemical expression of amelogenins in odontogenic epithelial tumours and cysts

Summary Amelogenins, enamel proteins in odontogenic tumours, were detected immunohistochemically using a monoclonal antibody. They were strongly expressed in amyloid-like material, ghost cells, and the cells surrounding ghost cells of calcifying epithelial odontogenic tumours and cysts, whereas calcified bodies within the tumours and cysts showed negative staining. The expression of amelogenins was also positive in tumour cells of ameloblastoma, adenomatoid odontogenic tumour, squamous odontogenic tumour and ameloblastic fibroma. Peripheral tumour cells of the follicular ameloblastoma were positive with relatively intense staining. Undifferentiated or flattened tumour cells of adenomatoid odontogenic tumour and non-keratinized tumour cells of the squamous odontogenic tumour showed marked staining. Reduced ameloblasts in the odontoma displayed the strongest staining for amelogenins. The study suggests that biosynthesis of amelogenins may occur in the homogeneous materials of calcifying epithelial odontogenic tumours and cysts.     

An orderly approach to the study of odontogenic tumours in animals.

In this paper odontogenic tumours in animals are discussed with the aim of developing a sound basis for further work in this relatively poorly understood field. The following recommendations are made: (1) Odontogenic tumours should be classified according to whether they are of epithelial, mesenchymal or of mixed epithelial and mesenchymal origin, rather than based on inductive changes. (2) The clinical behaviour implied by ameloblastoma, ameloblastic fibroma and odontoma should be carefully considered before these terms are incorporated into the diagnosis of any odontogenic tumour. (3) Caution should be exercised in designating specific odontogenic tumours in animals as being the counterpart of human tumours until their histopathological features and clinical behaviour have been proved to be equivalent. (4) Only tumours that exhibit the typical features of the basal cell layer of ameloblastomas should be designated as ameloblastomas. (5) Ameloblastic epithelium should not be used when odontogenic epithelium is intended. (6) These recommendations should be substantiated by reviewing odontogenic tumours in animals, although doing so will be difficult because of their rarity.     

Ameloblastic fibroma: A fine-needle aspiration case report

Fine-needle aspiration biopsy of an ameloblastic fibroma, an unusual odontogenic tumor related to ameloblastoma, was performed on a 38-yr-old man with a slowly enlarging left facial mass. Aspiration of the tumor yielded a cellular sample composed of a mixture of mesenchymal and epithelial cells, arranged, respectively, in thick mats and complex solid structures outlined by columnar cells with central regions reminiscent of stellate reticulum. A diagnosis of odontogenic tumor was conferred, and the lesion was surgically biopsied and then resected. The key cytologic feature distinguishing this lesion from other odontogenic tumors was fragments of hypercellular stroma. The differential diagnosis includes ameloblastoma, ameloblastic fibrosarcoma, other odontogenic tumors, intraosseous adenoid cystic carcinoma, trabecular adenoma, and basal-cell carcinoma. Diagn. Cytopathol. 1997; 17:280–286. © 1997 Wiley-Liss, Inc.     

Odontogenic sarcoma and carcinosarcoma

Odontogenic sarcoma is a gnathic malignant connective tissue tumor containing epithelium similar to that seen in an ameloblastoma or ameloblastic fibroma. It is a mixed odontogenic tumor in which the epithelial component is benign and the proliferative mesenchymal component is malignant. With each recurrence, the ameloblastic fibrosarcoma demonstrates increasing evidence of stromal cellularity and mitotic activity but diminishing evidence of odontogenic epithelium. If an ameloblastic fibrosarcoma exhibits dysplastic dentin, it can be called an ameloblastic fibrodentinosarcoma, and if it additionally shows focal deposits of dysplastic enamel proteins, it can be designated an ameloblastic fibro-odontosarcoma. A jaw tumor displaying both a carcinomatous and a malignant spindle cell component can be termed an odontogenic carcinosarcoma if it reveals an ameloblastic fibroma-like pattern. If it lacks this pattern, the appellations "spindle-cell ameloblastic carcinoma" or "biphasic ameloblastic sarcomatoid carcinoma" might be preferable. This is a US government work. There are no restrictions on its use.     

Granular cells in odontogenic and non-odontogenic tumours

Summary Granular cells can occur in various odontogenic and non-odontogenic tumours. 5 granular cell lesions, one granular cell ameloblastoma, one so-called granular cell ameloblastic fibroma and three granular cell tumours were examined immunohistochemically for the intermediate filaments cytokeratin, vimentin, desmin, neurofilaments and the neural markers NSE and S-100 protein. The granular cell tumors (granular cell myoblastoma) showed positive staining for vimentin and S-100 protein. Only vimentin could be demonstrated in the granular cells of the so-called granular cell ameloblastic fibroma, whereas the granular cell ameloblastoma showed positive staining only for cytokeratin. A positive reaction with S-100 protein was not found in any of the odontogenic tumours. In our opinion the mesenchymal odontogenic granular cell is a fibroblast, whereas the epithelial granular cell is derived from enamel epithelium. The term granular cell ameloblastic fibroma is a misnomer, as a number of these tumours are probably central odontogenic fibromas exhibiting granular cell transformation.     

Benigne „gemischte“ odontogene Tumoren

Benign "mixed"odontogenic tumors consist of an epithelial and ectomesenchymal tumor component, distinguishing them from pure epithelial and pure ectomesenchymal odontogenic tumors. In addition, they may have the ability to produce dentin, enamel or cementum. Therefore, they can sometimes already be differentiated radiologically from epithelial odontogenic tumors. Some of the mixed odontogenic lesions are regarded as true tumors (ameloblastic fibroma, odontoameloblastoma, dentinogenic ghost cell tumor), while others are assumed to represent hamartomatous lesions (complex and compound odontoma, probably also ameloblastic fibrodentinoma and ameloblastic fibroodontoma). Preceded by keratocystic odontogenic tumor, complex and compound odontomas are the second most common odontogenic tumors, while other members of the "mixed" odontogenic tumor group are far less frequently diagnosed. Odontoameloblastoma and dentinogenic ghost cell tumors are locally aggressive lesions that require total resection. All other lesions of this group are treated by local excision. Since ameloblastic fibrosarcoma may evolve from ameloblastic fibroma, patients with ameloblastic fibroma should remain in long-term follow-up.     

Ameloblastic fibrosarcoma: a cytologist's perspective

Fine-needle aspiration cytology of a case of ameloblastic fibrosarcoma (AFS), an unusual odontogenic tumor related to ameloblastoma (AB), was performed in a 25-year-old female with a 1 cm swelling in the left lower orbital region along with involvement of zygomatic region. Aspiration of the tumor yielded a cellular sample composed predominantly of mesenchymal element and few clusters representing epithelial component showing tall columnar cells with peripheral palisading. Detailed cytomorphological features of AFS are discussed along with differential diagnosis from other tumors such as AB, desmoplastic AB, odontogenic fibroma, ameloblastic fibrodentinoma and ameloblastic fibro-odontoma, ameloblastic fibroma.     

Use of calretinin in the differential diagnosis of unicystic ameloblastomas

AIMS: Calretinin, a 29-kDa calcium-binding protein is expressed widely in normal human tissues and tumours including both unicystic and solid and multicystic ameloblastomas. The histological distinction between unicystic ameloblastomas and certain non-neoplastic odontogenic cysts can be problematic. The objective of this study was to determine whether calretinin was expressed in the lining epithelium of odontogenic keratocysts, residual and dentigerous cysts and to determine whether this calcium-binding protein could be used to distinguish these cysts from the unicystic ameloblastoma. METHODS AND RESULTS: The lining epithelium in 22 cases of odontogenic keratocyst, 26 cases of residual cyst and 20 cases of dentigerous cyst were examined for the expression of calretinin. No positive epithelial staining was observed in any of these cystic lesions. In comparison, however, 81.5% of cases of unicystic ameloblastoma showed a coarse dark brown staining of the more superficial epithelial cell layers. Scattered positive stromal and epithelial cells were present; these were interpreted as mast cells. CONCLUSIONS: Calretinin appears to be a specific immunohistochemical marker for neoplastic ameloblastic epithelium and we suggest that it may be an important diagnostic aid in the differential diagnosis of cystic odontogenic lesions and ameloblastic tumours.     

Immunohistochemical localization of large chondroitin sulfate proteoglycan in odontogenic tumor

The present study investigated the localization of versican in odontogenic tumors by immunohistochemistry, using paraffin-embedded sections obtained from 27 patients with odontogenic tumors (17 ameloblastomas, 1 adenomatoid odontogenic tumor, 4 odontogenic keratocysts, 1 calcifying odontogenic cyst, 2 ameloblastic fibromas, and 2 malignant ameloblastomas). Deparaffinized sections were immersed in a buffered 1 : 1000 solution of an antibody, 5D5 (raised against a large chondroitin sulfate proteoglycan from bovine sclera), which mainly recognizes versican. All samples showed a positive reaction for versican in connective tissues, whereas positive staining of epithelial nests was observed in only some samples. The positive staining in epithelial nests was in areas showing stellate reticulum-like, cuboidal, columnar cells at the periphery, and tear-drop structures. These results indicated that versican might be involved in, at least in part, the morphogenesis of neoplastic epithelium and mesenchymal tissues in odontogenic tumors.     

Primordial odontogenic tumor occurred in the maxilla with unique calcifications and its crucial points for differential diagnosis

Primordial odontogenic tumor (POT) is a newly classified, mixed epithelial and mesenchymal odontogenic tumor, with only 17 reported cases to date. Herein, we report a case of POT that occurred in the right maxilla of a 10-year-old boy and reveal unique features in comparison with those previously reported. Radiologically, the lesion presented as a well-defined, unilocular radiolucency with notable radiopaque foci on the periphery. Microscopically, the tumor was mainly composed of dental papilla-like myxoid fibrous connective tissue, largely surrounded by non-keratinized squamous epithelium with numerous calcified particles, and partly enclosed by inner enamel epithelium-like columnar cells and enamel organ-like structures accompanied with cuboidal and/or stellate reticulum-like cells. Immunohistochemically, the epithelium tested positive for cytokeratin 14 and 19. Moreover, amelogenin and ameloblastin, matrix proteins relating to enamel formation, were positive in the covering epithelium. The tumor was enucleated as a whole, and no recurrence was recorded thereafter. Although the presence of numerous calcified particles was unique, we diagnosed this lesion as POT based on the above-described features. Furthermore, we emphasize the importance of the differential diagnosis of POT and other odontogenic tumors that resemble corresponding tooth germ components.     

Malignant epithelial odontogenic tumors

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.     

Immunohistochemical expression of neural tissue markers (neuron-specific enolase, glial fibrillary acidic protein, S100 protein) in ameloblastic fibrodentinoma: a comparative study with ameloblastic fibroma

Formalin-fixed paraffin-embedded sections of three cases of ameloblastic fibrodentinoma (AFD) were studied by the avidin-biotin-peroxidase complex method using antibodies against neuron-specific enolase (NSE), glial fibrillary acidic protein (GFAP) and S100 protein and the results were compared with those in ameloblastic fibroma (AF). A striking histopathological characteristic of AFD was the formation of abortive dentin with various degrees of maturation at the epithelial-mesenchymal tissue interface. Central cells of enamel organ-like epithelia with various stages of abortive dentin induction in AFD were generally positive for NSE. Dental lamina-like epithelial cells also showed positive staining in some areas. No cells were positive for NSE in AF. Positive staining for GFAP was observed in the juxta-epithelial mesenchymal tissue of the formation stage of immature dentin with various numbers of entrapped cells in AFD, but GFAP staining was negative in other mesenchymal and epithelial tissues at other stages. In AF, no GFAP-positive cells were found. There were a few S100 protein-positive cells found in the foci of epithelial components in both AFD and AF. Mesenchymal cells showing a dendritic or spindle shape were positive for S100 protein in some areas of AFD and AF. Although such cells in the mesenchymal component of pigmented AFD were more numerous than in non-pigmented AFD and AF, their distribution pattern in the former condition was basically similar to that in the latter. Although the present results, obtained from conventional immunohistochemical procedures, do not directly reflect the expression of neural crest-derived cells in the dentinogenesis of AFD, such results do not disprove the possibility of the expression of neural proteins probably related to neural crest-derived cells in dentinogenesis under certain pathologic conditions in odontogenic mixed tumors. Such a phenomenon may also occur during dentinogenesis in other odontogenic mixed tumors and in normal tooth differentiation, but at an undetectable level.     

Immunohistochemical demonstration of an enamel sheath protein, sheathlin, in odontogenic tumors

Enamel proteins can be useful markers for assessment of the functional differentiation of neoplastic epithelium and the nature of extracellular matrices in odontogenic tumors. In the present study, we examined immunohistochemical localization of sheathlin, a recently cloned enamel sheath protein, in various odontogenic tumors to evaluate functional differentiation of tumor cells and the nature of hyalinous or calcified matrices in odontogenic neoplasms. Distinct immunolocalization of sheathlin was observed in the immature enamel of the tooth germ at the late bell stage. Secretory ameloblasts facing the enamel matrix also showed positive staining in their cytoplasm. Definite localization of sheathlin was demonstrated in the enamel matrix in odontogenic tumors with inductive dental hard tissue formation such as ameloblastic fibroodontomas and odontomas. Immunoexpression of sheathlin was, furthermore, demonstrated in eosinophilic droplets in solid nests of adenomatoid odontogenic tumor (AOT) and ghost cells in the epithelial lining of calcifying odontogenic cyst (COC). In AOT, cells facing the eosinophilic droplets also expressed the protein in their cytoplasm. There was neither intracellular staining for sheathlin in the tumor cells nor extracellular staining in the matrix of ameloblastomas and calcifying epithelial odontogenic tumors. Dentin, dysplastic dentin-like hyaline material and cementum in the tumors examined were negative for sheathlin. These results show that immunodetection of sheathlin is a useful marker for functional differentiation of secretory ameloblasts and enamel matrix, which is often hard to differentiate from other hard tissues in odontogenic tumors. Our findings from the view point of sheathlin expression support that the tumor cells of ameloblastomas do not attain full differentiation into functional ameloblasts. It is very interesting that epithelial cells in odontogenic tumors can differentiate into functional ameloblasts without induction by odontogenic mesenchyme, as shown by immunoexpression of sheathlin in eosinophilic droplets within solid epithelial sheets in AOT and ghost cells in the epithelial lining of COC where inductive participation of mesenchymal cells was most unlikely. Received: 19 May 1999 / Accepted: 27 September 1999     

Midkine expression correlating with growth activity and tooth morphogenesis in odontogenic tumors

Midkine (MK; a low molecular weight heparin-binding growth factor) is a multifunctional cytokine. MK plays a role in morphogenesis of many organs including teeth through epithelial-mesenchymal interactions. We immunohistochemically examined MK expression in various human odontogenic tumors. There was no difference in positive rate and intensity of MK between benign odontogenic tumors and their malignant counterparts. Ameloblastoma showed MK localization in the peripheral columnar cells in budding processes from the parenchyma, which frequently expressed proliferating cell nuclear antigen. MK was also preferentially expressed in keratinized cells in acanthomatous ameloblastoma and keratocystic odontogenic tumor. In odontogenic mixed tumors except for odontoma, intense immunoreactivity to MK was found in epithelial follicles, the surrounding odontogenic ectomesenchymal tissue, and the basement membrane between them. Intensity in the odontogenic ectomesenchyme decreased in relation to distance from the epithelial follicles. No expression was found in tumor cells associated with production of dental hard tissues in odontogenic mixed tumors including odontoma. These findings suggested that MK is involved in the reciprocal interaction between odontogenic epithelium and odontogenic ectomesenchymal tissue in areas without dental hard tissue formation in odontogenic mixed tumors. Coexpression of MK and proliferating cell nuclear antigen was also observed in epithelial follicles and highly cellular nodules in the ectomesenchyme of odontogenic mixed tumors. MK is considered to mediate growth activity of odontogenic tumors and cell differentiation of odontogenic mixed tumors through molecular mechanisms similar to those involved in morphogenesis of the tooth.     

Immunohistochemical localization of amelogenin in human odontogenic tumors, using a polyclonal antibody against bovine amelogenin

In the present study, we investigated the localization of amelogenin in odontogenic tumors, using an anti-amelogenin polyclonal antibody. In order to make the antibody, antisera against an amelogenin fraction obtained from the enamel matrix of unerupted bovine tooth was raised in rabbits. By Western blot analysis, a main band of 25 kDa and six minor bands (6.8, 12, 18, 20, 23, and 27 kDa) were detected under nonreducing conditions. Immunoreactivity for the amelogenin was observed in ameloblasts and in the immature enamel matrix of 4-day-old rats. In odontogenic tumors, positive reactions for amelogenin were localized in limited areas in adenomatoid odontogenic tumor, calcifying odontogenic cyst, primary intraosseous carcinoma and odontoma. The strongest immunoreactions were shown in enamel matrices in odontomas. Small mineralized foci in epithelial nests showed positive reactions, and a few reactions were observed in epithelium adjacent to the mineralized foci. In calcifying odontogenic cysts, some ghost cells in the lining epithelium were strongly stained. The results indicate that the present antibody for amelogenin is useful for the determination of odontogenic tumors, especially in those in which small mineralized foci are present in the epithelial nests.     

Histological and three dimensional organization of the odontogenic organ in the lower incisor of 100 gram rats

A three dimensional reconstruction of the epithelial tissue at the apical end of the lower rat incisor was made from serial 1 μm thick cross sections. This tissue formed an elongated structure, called the odontogenic organ, which was composed of a bulbous and a “U”-shaped part. Both parts were joined to one another at the posterior aspect of the apical foramen. The bulbous part of the odontogenic organ was situated at the lingual side of the “U”-shaped part and protruded anteriorly over the pulp. It was formed by cells of the outer dental epithelium and stellate reticulum whose organization suggested that the bulbous part was important in the production of cells for renewal of all the epithelia of the incisor. The “U”-shaped part of the odontogenic organ was apparently derived from the bulbous part and delineated the pulp by forming the lateral, mesial and labial sidewalls around the apical foramen. It was composed of all the epithelial cell types recognizable as precursors to (a) cells of the enamel organ which form the enamel, and (b) Hertwig's epithelial root sheath, a part of the odontogenic organ which induces the formation of dentin on the lingual aspect of the incisor.     

Epithelial cytodifferentiation and extracellular matrix formation in enamel-free areas of the occlusal cusp during development of mouse molars: Light and electron microscopic studies

Mandibular first molars in mice ranging in age from 18 days prenatal to 5 days postnatal were used for light and electron microscopic examinations of the enamel-free area (EFA) during development of the occlusal cusp (mesiobuccal cusp). Notable morphological changes in the inner enamel epithelium and the cells of the stratum intermedium were observed. At prenatal age of 18 days, the inner enamel epithelium of the EFA (EFA epithelium) was composed of a layer of columnar cells and covered by the cells of the stratum intermedium. Two days after birth, the EFA epithelium was made up largely of preameloblasts, with mitochondria located in the proximal side of the cells toward the stratum intermedium. The cells of the stratum intermedium were irregularly shaped, with wide intercellular spaces between them. At a postnatal age of 3 days, most of the EFA epithelial cells resembled maturation-stage ameloblasts, being short and columnar in shape and having nuclei located in their proximal side. Distal cell membranes were folded, and mitochondria were scattered throughout the cytoplasm. In 4-day-old mice, the EFA epithelium was found to be formed of short columnar or cuboidal cells with distinct intercellular spaces. The cells of the stratum intermedium could no longer be detected, and cells of the EFA epithelium could not be distinguished from those of the stellate reticulum. Odontoblasts of the EFA were arranged and polarized parallel to the basal lamina, and odontoblastic processes extended toward the cusp tip. The orientation of thin and thick collagen fibers within predentin and dentin was also parallel to the basal lamina. Even after dentin mineraliza tion, disrupted basal lamina and long, aperiodic, fine fibrils were found between the epithelium and the dentin. Following the disappearance of the basal lamina and fine fibrils, stippled material and crystals appeared on the dentin surface. The mineralized matrix, which x-ray microanalytical energy peaks identified as containing calcium and phosphorus, was continuous with enamel in the distal slope of the cusp at the cusp tip. Thus, the inner enamel epithelium of the EFA differentiated into secretory cells capable of enamel-like matrix formation. In conclusion, development of EFA in mouse molars seems to be a system suitable for use in studying both the involvement of extracellular matrix, including basal lamina constituents, in ameioblast differentiation, and the role of the cells of the stratum intermedium, together with the ameloblasts, in comprising a single functional unit responsible for enamel formation.     

Classification and behaviour after surgery of canine 'epulides'

Seventy-five surgically excised canine gum neoplasms, which had previously been diagnosed as epulis or ameloblastoma, were reclassified on the basis of their presumed tissue of origin. They included 42 tumours of fibroblastic origin, which contained small foci of odontogenic epithelium and were classified as peripheral odontogenic fibroma, whilst 31 epithelial tumours were classified as basal cell carcinomas arising from the gum epithelium. Two epithelial tumours which apparently arose within the bone of the mandible and were not connected with the surface mucosa were classified as ameloblastomas. Follow-up studies after surgery revealed a recurrence rate of 17 per cent for the odontogenic fibromas and 50 per cent for basal cell carcinomas. Neither of the ameloblastomas, which were initially treated by radical excision, recurred locally and no metastases were detected from any of these tumours.     

Nestin expression in odontoblasts and odontogenic ectomesenchymal tissue of odontogenic tumours

BACKGROUND: Nestin, one of the intermediate filaments constituting the cytoskeleton, is a marker of neural stem cells or progenitor cells. Its expression is also related to tooth development and repair of dentine. AIMS: The aim of this study was to investigate nestin expression in various odontogenic tumours and evaluate its usefulness for histopathological diagnosis. METHODS: We studied formalin fixed, paraffin embedded specimens from 129 cases of odontogenic tumours and 9 of mandibular intraosseous myxoma. After characterisation of odontogenic ectomesenchymal tissues in these tumours using antibodies to vimentin, desmin, neurofilament, and glial fibrillary acidic protein, we immunohistochemically examined nestin expression. RESULTS: No differentiation towards muscle and nervous tissues was found in the odontogenic ectomesenchymal tissues. Although almost all the ameloblastomas and malignant ameloblastomas were negative for nestin, odontogenic ectomesenchyme in the odontogenic mixed tumours demonstrated nestin immunolocalisation, particularly in the region adjacent to the odontogenic epithelium. Odontoblasts and their processes, pulp cells near the positive odontoblasts, and flat cells adhering to the dentine showed immunoreaction with nestin in the odontomas and odontoma-like component in the ameloblastic fibro-odontomas. Neoplastic cells in almost half cases of jaw myxoma and one case of odontogenic fibroma expressed nestin. CONCLUSIONS: The distribution of nestin in the odontogenic mixed tumours suggests that nestin expression in the odontogenic ectomesenchyme is upregulated by stimulation from odontogenic epithelium. In addition, nestin may also be involved in the differentiation from pulp cells to odontoblasts in odontogenic tumours. Therefore, nestin is a useful marker for the odontogenic ectomesenchyme and odontoblasts in odontogenic tumours. Nestin, one of the intermediate filaments constituting the cytoskeleton, is a marker of neural stem cells or progenitor cells. Its expression is also related to tooth development and repair of dentine.