Extrafollicular Adenomatoid odontogenic tumour presenting as a periapical lesion: Report of a rare entity

Adenomatoid odontogenic tumour (AOT) has been known to the pathologists for the past 100 years as a benign slow growing tumour. Histologically, this tumour has a predominantly solid component and very few case reports have described the cystic nature of AOT. In the present case we review the literature of extrafollicular AOT presenting as a periapical disease and add to the literature a case of cystic extrafollicular AOT in a 17-year-old patient, initially diagnosed as a radicular cyst. Radiographically extrafollicular AOT frequently resembles other odontogenic lesions such as residual, developmental lateral periodontal or radicular cyst, however histopathological findings of this tumour are quite characteristic and present few diagnostic problems. Correlation of clinical and radiological information with histological features is important in the diagnosis of odontogenic cysts and tumours, to decrease the incidence of misdiagnosis for such cases and this in turn will help in preventing recurrences.     

Adenomatoid odontogenic tumour: Tumour or a cyst, a histopathological support for the controversy

Adenomatoid odontogenic tumour (AOT) is a well-established odontogenic tumour with various clinicopathological variants. AOT quite frequently mimics an odontogenic cyst commonly a dentigerous cyst. Histologically a cystic component of AOT has been described in the literature. In the present paper we review the literature for the AOTs arising in an odontogenic cyst and add to the literature a case of cystic AOT. The present review is aimed to provide an insight to the varied demographic profile, clinical behavior and prognosis of cystic variant of AOT.     

Unusual presentation of localized gingival enlargement associated with a slow-growing odontogenic myxoma

Unusual presentation of localized gingival enlargement associated with a subjacent tumoural pathology is reported.The patient was a55-year-old black male,whose chief complaint was a progressive gingival overgrowth for more than ten years,in the buccal area of the anterior left mandible.According to the clinical features and the radiological diagnosis of odontogenic keratocyst,a conservative surgery with enucleation and curettage was performed.Tissue submitted for histopathological analysis rendered the diagnosis of odontogenic myxoma.After 12-month of follow-up,no evidence of recurrence was found.Clinicians should be cautious when facing any gingival enlargement to avoid diagnostic pitfalls and to indicate the appropriate treatment.     

Two-stage treatment protocol of keratocystic odontogenic tumour in young patients with Gorlin-Goltz syndrome: marsupialization and later enucleation with peripheral ostectomy. A 5-year-follow-up experience

Objective

Keratocystic odontogenic tumour (KCOT) is a benign uni- or multicystic intraosseous odontogenic tumour with potential for local destruction and tendency for multiplicity, especially when associated with Gorlin–Goltz syndrome. We suggest a conservative surgical treatment based on marsupialization and later enucleation with peripheral ostectomy in order to preserve jaw's integrity in young patients.

Methods

Three young patients affected of nevoid basal cell carcinoma syndrome (NBCCS or Gorlin–Goltz syndrome) presented large and multiple KCOTs, which have been treated following a two-stage surgical strategy. Initially marsupialization was performed and after a mean period of 10 months, contextually to evident reduction in radiological size image, enucleation with peripheral ostectomy was carried out.

Results

All the patients showed high collaboration in daily self-irrigation of the stomia with chlorhexidine 0.2% during the period of marsupialization. Definitive surgical intervention led to complete healing and no signs of recurrence have been observed during a 5-year-follow-up.

Conclusions

The main advantage of this modality is the preservation of important anatomical structures involved in the lesion and jaw's continuity. Therefore in a selected group of cooperative patients, especially those affected of Gorlin–Goltz syndrome, the surgical protocol exposed allows for a less invasive approach with excellent results avoiding extensive disfiguring procedures.     

Odontogenic Keratocyst of mandible

The Odontogenic Keratocyst is a developmental odontogenic cyst and deserves special attention because of its peculiar histopathologic features and biologic behavior. It is believed that the Odontogenic Keratocyst arises from the proliferation of remnants of dental lamina. It is usually asymptomatic, and solitary lesion, however, it may be associated with Nevoid Basal Cell Carcinoma Syndrome. This work aimed to present a case of a very extensive Odontogenic Keratocyst in a 28-year-old woman.     

Microbiology of acute and chronic maxillary sinusitis associated with an odontogenic origin

OBJECTIVES:: To study the microbiology of sinusitis associated with odontogenic origin. METHODS:: Aspirates of 20 acutely and 28 chronically infected maxillary sinuses that were associated with odontogenic infection were processed for aerobic and anaerobic bacteria. RESULTS:: A total of 66 isolates were recovered from the 20 cases of acute sinusitis (3.3/specimen), 16 aerobic and facultatives, and 50 anaerobic. Aerobes alone were recovered in 2 (10%) specimens, anaerobes only in 10 (50%), and mixed aerobic and anaerobic bacteria in 8 (40%). The predominant aerobic were alpha-hemolytic streptococci (5), microaerophilic streptococci (4), and Staphylococcus aureus (2). The predominant anaerobes were anaerobic Gram-negative bacilli (22), Peptostreptococcus (12), and Fusobacterium spp. (9). A total of 98 isolates were recovered from the 28 cases of chronic sinusitis (3.5/patient): 21 aerobic and facultatives and 77 anaerobic. Aerobes were recovered in 3 (11%) instances, anaerobes only in 11 (39%), and mixed aerobic and anaerobic bacteria in 14 (50%). The predominant aerobes were alpha-hemolytic streptococci (7), microaerophilic streptococci (4), and S. aureus (5). The predominant anaerobes were Gram-negative bacilli (41), Peptostreptococcus (16), and Fusobacterium spp. (12). Thirteen beta-lactamase-producing bacteria (BLPB) were recovered from 10 (50%) patients with acute sinusitis and 25 BLPB from 21 (75%) patients with chronic sinusitis. No correlation was found between the predisposing odontogenic conditions and the microbiological findings. CONCLUSIONS:: These data illustrate the similar microbiology of acute and chronic maxillary sinusitis associated with odontogenic infection where anaerobic bacteria predominate in both types of infections.     

Sclerosing odontogenic carcinoma — review of all published cases: is it a justifiable addition as a malignancy?

IntroductionSclerosing odontogenic carcinoma was a new addition to the list of head and neck tumors by World Health Organization in 2017. This lesion has scarcely been reported and a lack of pathognomonic markers for diagnosis exists.ObjectiveThe aim of the study was to summarize findings from the available literature to provide up-to-date information on sclerosing odontogenic carcinoma and to analyse clinical, radiological, and histopathological features to obtain information for and against as an odontogenic malignancy.MethodsWe conducted a comprehensive review of literature by searching Pubmed, EBSCO and Web of Science databases, according to PRISMA guidelines. All the cases reported as sclerosing odontogenic carcinoma in English were included. Data retrieved from the articles were gender, age, clinical features, site, relevant medical history, radiographical findings, histopathological findings, immunohistochemical findings, treatments provided and prognosis.ResultsMean age at diagnosis of sclerosing odontogenic carcinoma was 54.4 years with a very slight female predilection. Sclerosing odontogenic carcinoma was commonly reported in the mandible as an expansile swelling which can be asymptomatic or associated with pain or paraesthesia. They appeared radiolucent with cortical resorption in radiograph evaluation. Histologically, sclerosing odontogenic carcinoma was composed of epithelioid cells in dense, fibrous, or sclerotic stroma with equivocal perineural invasion. Mild cellular atypia and inconspicuous mitotic activity were observed. There is no specific immunohistochemical marker for sclerosing odontogenic carcinoma. AE1/AE3, CK 5/6, CK 14, CK19, p63 and E-cadherin were the widely expressed markers for sclerosing odontogenic carcinoma. Surgical resection was the main treatment provided with no recurrence in most cases. No cases of metastasis were reported.ConclusionFrom the literature available, sclerosing odontogenic carcinoma is justifiable as a malignant tumor with no or unknown metastatic potential which can be adequately treated with surgical resection. However, there is insufficient evidence for histological grading or degree of malignancy of this tumor.     

Lymphangioma of the larynx as a cause of progressive dyspnea

The following is a case report of a lymphangioma of the larynx in a 16-year-old girl with Down's Syndrome. The clinical record of the girl, the diagnosis of the tumour and its surgical treatment as well as the postoperative course and the follow-up results are described.     

Malignant odontogenic tumors: a 22-year experience

OBJECTIVES/HYPOTHESIS: Malignant odontogenic tumors are exceedingly rare and arise from odontogenic epithelial residues and odontogenic cysts in the jaw bones. Odontogenic malignancies have various origins. Some develop directly from the remnants of odontogenic epithelium left after completion of dental development; others may result from malignant transformation of a benign odontogenic cyst or ameloblastoma. These lesions are usually locally aggressive with radical surgery being the primary mode of treatment. Because of their rarity, much of the existing information about malignant odontogenic tumors with regard to their origin, clinicopathological features, biological behavior, and therapeutics is derived from case reports or small series. The study represents one of the largest series of malignant odontogenic tumors compiled in a single institution. STUDY DESIGN: Retrospective 22-year review from an Academic Medical Center. METHODS: Twenty cases of reported malignant odontogenic tumors were diagnosed in the authors' institution between 1981 and 2002. All pathological slides were reviewed to reconfirm diagnosis. Malignancy was confirmed based on the following criteria: histological findings of infiltrative growth, atypical cytological features, and focal necrosis or clear evidence of distant metastatic spread. Patient age, race, sex, treatment and outcome were recorded on chart review. RESULTS: Of the twenty reported cases, only nine were actually found to be malignant tumors on re-evaluation. These consisted of four cases of malignant ameloblastomas, two cases of ameloblastic carcinoma, one case of malignant Pindborg tumor (calcifying epithelial odontogenic tumor), one case of odontogenic ghost cell carcinoma, and one case of squamous cell carcinoma arising in an odontogenic keratocyst. The racial demographics were six Caucasian patients, one African American patient, and two Asian patients; seven men and two women represented the gender distribution. Tumors of six cases were located in the mandible, and of three cases, in the maxilla. All cases were treated with radical surgical excision. Two patients died of their disease, three patients were alive and free of disease, and four patients were lost to follow-up. CONCLUSION: Malignant odontogenic tumors are rare. They require a multidisciplinary team to determine proper treatment. Long-term surveillance is mandatory and is accomplished by routine physical examinations, along with serial radiographic imaging.     

Clear-cell variant of calcifying epithelial odontogenic tumor (Pindborg tumor) in the mandible

We present an uncommon case (female patient aged 59 years) of the clear-cell variant of calcifying epithelial odontogenic tumor (CEOT) (also known as Pindborg tumor) in the mandible. The clinical characteristics and probable origins of the clear tumor cells of previously reported cases of clear-cell variant of intraosseous CEOT are also summarized and discussed.     

Ameloblastoma demographic,clinical and treatment study - analysis of 40 cases

Dental lesions represent about 1% of oral cavity tumors being ameloblastoma the most common one. It is a tumor of epithelial origin that mainly affects the jaw, and less commonly the maxilla. Its clinical presentation is that of an asymptomatic slow-growing tumor. Despite being a benign tumor, it has an invasive behavior with a high rate of recurrence if not treated properly.ObjectiveTo describe the cases of ameloblastoma in a reference department.MethodsRetrospective analysis of 40 cases. The variables analyzed were: age, gender, ethnicity, tumor location, type of treatment, complications and recurrence.ResultsThe most affected gender was male - 21 cases (52.5%); with a predominance of Caucasians - 24 cases (60%). The mean age was 35.45 years; the most common location was in the jaw - 37 cases (92.5%). Facial asymmetry was the most frequent complaint. Of the 40 cases, 33 were submitted to surgery. Of those submitted to surgery, 24 (72.72%) underwent segmental resection, with recurrence in 4 (12.12%) cases.ConclusionAmeloblastoma may relapse when treatment is not performed with broad surgical resection of the lesion with wide safety margins.     

Radiation-induced fibrosarcoma of the tongue

Three patients with a radiation-induced fibrosarcoma of the tongue are presented. All three patients had interstitial radiotherapy and tumour-induction by irradiation seems to be the most likely explanation for the tumour in these patients.     

Radiation‐induced cancers of the pharynx and larynx: a study of five clinical cases

Radiation‐induced cancers of the pharynx and larynx: a study of five clinical cases Radiation‐induced cancer, a rare clinical entity, is often difficult to diagnose and manage. This study reports a series of five cases of radiocarcinogenesis of the pharynx and/or larynx that developed after external radiotherapy. The primary lesion was diagnosed at a mean age of 50 years (±12.9) and the radiation‐induced cancer at a mean age of 59 years (±13.1), giving a latent period of 9 years (±3.7). Analysis of gammagraphic records indicated that four of the patients had developed a secondary tumour in the penumbra of irradiation fields. In these zones, the delivered dose was between 20 and 80% of the prescribed dose, corresponding to an estimated cumulative mean dose of 14.1–56.3 Gy. These results are compared with data in the literature to determine the diagnostic criteria for radiation‐induced cancer, possible predisposition (genetic or acquired) and the dose effect.