Adenomatoid odontogenic tumor mimicking a periapical (radicular) cyst: A case report

doi:10.1067/moe.2002.124767

Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology

Volume 94, Issue 2, August 2002, Pages 246-248

https://doi.org/10.1067/moe.2002.124767 Get rights and content

Abstract

The adenomatoid odontogenic tumor (AOT) is a benign (hamartomatous), noninvasive lesion with slow but progressive growth. A rare subvariant of the extrafollicular type of AOT may mimic periapical disease radiographically. We report on a 15-year-old girl with a periapical radiolucent lesion affecting teeth 7 and 8 initially suspicious of periapical disease, although clinical findings seemed to indicate a nonendodontic lesion. An exploratory surgical approach was chosen, and the final diagnosis of the removed noncystic tissue mass was microscopically confirmed to be an AOT. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002;94:246-8)

Section snippets

Case report

A Thai girl, age 15 years, was referred for diagnosis of a periapical lesion localized to the area of teeth 7 and 8. The asymptomatic lesion was detected during routine radiographic examination in preparation for orthodontic treatment. Medical history was noncontributory. Clinical examination did not show any coronal or endodontic pathologic condition of teeth 7 and 8, both of which reacted positively to electrometric pulp testing, as did all maxillary incisors. Periapical radiographs showed a

Discussion

The case described illustrates characteristic clinical and radiographic features of the extrafollicular variant of the AOT mimicking a periapical lesion. There were, in fact, a number of clinicoradiologic indicators that could have suggested that this case in a 15-year-old girl was a possible extrafollicular AOT, although this subvariant is indeed a rarity. The age distribution of patients with AOT shows a peak in the second decade²; the female sex is almost twice as often affected as the male.⁶

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There are more references available in the full text version of this article.

Cited by (59)

Extrafollicular Adenomatoid Odontogenic Tumor. An unusual case report and review of the literature
2023, Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology
Citation Excerpt :
This type is frequently observed between the roots of erupted adjacent teeth [4]. According to Philipsen [1,9,12], the extrafollicular AOT variant can occur in four different places: intraosseous without relation to the retained dental organ, intraradicular, periapical, and radicular middle third. The peripheral type is extraosseous and originates from the gingival tissue but is extremely unusual [13,14].
Adenomatoid Odontogenic Tumor (AOT) is an uncommon odontogenic benign epithelial neoplasm. It accounts for about 2.2–7.1 % of all odontogenic tumors. Two clinicopathological intraosseous variants (Follicular and Extrafollicular) and one extraosseous variant (Peripheral) have been described. The follicular variant is considered the predominant form (about 75 % of all reported cases). An unerupted maxillary canine is the tooth most commonly associated with a follicular AOT (FAOT). The extrafollicular type (EAOT) is infrequent and is not related to an unerupted tooth. EAOT variant do not show distinctive clinical radiological features. Recurrence is very rare, which justify its conservative treatment. In this paper, we report a case of a 15-year-old female who had EOAT in the anterior mandible. Additionally, an update review on the etiology, age and gender distribution, tumor localization, clinic and radiological presentation, symptoms, histopathology/immunohistochemistry (IHC), diagnosis, treatment and recurrence of this condition is presented.
An international collaborative study of 105 new cases of adenomatoid odontogenic tumors
2021, Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Citation Excerpt :
This finding may represent a pitfall in microscopic differentiation from dentigerous cysts, particularly during evaluation of small samples incisional biopsy samples obtained in a setting of limited radiographic support. In fact, cystic or pseudocystic spaces in odontogenic tumors has been widely reported in the literature3,8,24; however, many authors still question whether these changes represent hybrid lesions or single microscopic changes. We observed a single case of AOT with microcystic compartments that affected the left maxilla in a South African man, who had a multilocular radiolucent lesion with remarkable root resorptions of all teeth; this expands the histopathologic spectrum of AOTs, similarly described in a recently published case of a Pindborg tumor.34
The aim of this study was to report the clinicopathologic features of 105 new cases of adenomatoid odontogenic tumor (AOT) from Brazil, Guatemala, Mexico, and South Africa.
Clinical and radiographic data were collected from records of 5 oral pathology laboratories, and all cases were microscopically reviewed.
This series of cases included 36 (34.2%) from South Africa; 33 (31.4%) from Brazil; 23 (21.9%) from Mexico; and 13 (12.3%) from Guatemala. Seventy-two patients (68.5%) were females and 33 patients (31.4%) were males, with an average age of 19.2 years. The tumors predominantly affected the anterior maxilla (48.5%), followed by the anterior mandible (29.5%); posterior mandible (15.2%); and posterior maxilla (6.6%). Sixty-three tumors (63.6%) were follicular, 34 (34.3%) were extrafollicular, and 2 (2%) were peripheral. In most cases, the tumors caused considerable cortical expansion (average size 3.4 cm). Microscopically, most cases showed rosette-like and duct-like structures.
This is one of the largest case series of AOTs reported in the literature and the first multicenter study involving populations from Latin America and South Africa. In a fifth of the present cases, the posterior regions of the gnathic bones were affected and the tumors demonstrated larger sizes compared with cases occurring in other populations.
Odontogenic keratocyst: The role of the orthodontist in the diagnosis of initial lesions
2017, American Journal of Orthodontics and Dentofacial Orthopedics
Odontogenic keratocysts (OKCs) are locally infiltrative odontogenic cysts that are usually diagnosed during routine radiographic examinations. Therefore, it is critical that dental practitioners, in particular orthodontists, recognize and diagnose OKCs to recommend appropriate treatment. This report describes a patient whose OKC was not initially identified during orthodontic pretreatment. In addition, this report discusses the clinical and radiographic features of OKCs, as well as the differential diagnoses of these lesions.
Extrafollicular Adenomatoid odontogenic tumour presenting as a periapical lesion: Report of a rare entity
2014, International Journal of Pediatric Otorhinolaryngology Extra
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.
Nonendodontic lesions misdiagnosed as apical periodontitis lesions: Series of case reports and review of literature
2014, Journal of Endodontics
Citation Excerpt :
Reports about nonendodontic lesions mimicking apical periodontitis and their misdiagnosis can be frequently found in the literature. This fact occurs because lesions, especially those of neoplastic origin, can present an aspect of radiolucency in the jaws (8–11). In 2012, Koivisto et al (12), analyzing the frequency and distribution of radiolucent jaw lesions in 9,723 cases, found that 73% represented apical granulomas and cysts, 8.8% keratocystic odontogenic tumors, 1.3% central giant cell lesions, 1.2% ameloblastomas, and less than 1% metastatic lesions.
This study aimed to analyze cases referred from a reference service in oral pathology that were initially misdiagnosed as periapical lesions of endodontic origin and to perform a review of the literature regarding lesions located in the apical area of teeth with a nonendodontic source.
A survey was made of clinical cases derived from the service of oral pathology from 2002 to 2012. The pertinent literature was also reviewed using ScienceDirect and PubMed databases. The lesions were grouped into benign lesions mimicking endodontic periapical lesions (BLMEPLs), malignant lesions mimicking endodontic periapical lesions (MLMEPLs), and Stafne bone cavities. The clinical presentations were divided into lesions with swelling without pain, lesions with swelling and pain, and lesions without swelling but presenting with pain.
The results showed that 66% (37/56) of cases represented benign lesions, 29% (16/56) malignant lesions, and 5% (3/56) Stafne bone cavities. The most commonly reported BLMEPLs were ameloblastomas (21%) followed by nasopalatine duct cysts (13.5%). The most frequently cited MLMEPLs were metastatic injuries (31.5%) followed by carcinomas (25%). The main clinical presentation of BLMEPLs was pain, whereas that of MLMEPLs was swelling associated with pain; Stafne bone cavities displayed particular clinical findings.
Clinical and radiologic aspects as well as the analysis of the patients' medical history, pulp vitality tests, and aspiration are essential tools for developing a correct diagnosis of periapical lesions of endodontic origin. However, if the instruments mentioned earlier indicate a lesion of nonendodontic origin, a biopsy and subsequent histopathological analysis are mandatory.
Immunohistological features in adenomatoid odontogenic tumor: Review of the literature and first expression and mutational analysis of β-catenin in this unusual lesion of the jaws
2013, Journal of Oral and Maxillofacial Surgery
Citation Excerpt :
The reason for such a female prevalence is unknown. AOT are more often located in the maxilla than mandible13,19,20 with a ratio of 2/1. Most lesions are found in the anterior region of the upper jaw.
To investigate for the first time the immunohistochemical and mutational status of β-catenin in a mandibular case of adenomatoid odontogenic tumor (AOT) and to review the immunohistochemical expression data of various markers (cytokeratins, metalloproteinases, etc) in such a lesion.
A case of follicular-type AOT in a young male patient was analyzed in regard to the immunohistochemical expression of β-catenin and mutations of the β-catenin gene (CTNNB1). Its expression is altered in some odontogenic tumors.
We found a strong cytoplasmic expression of β-catenin, but no molecular anomaly within the exon 3 of CTNNB1. β-catenin is considered to play a role in cell differentiation processes.
Our results were consistent with previous findings in ameloblastoma and malignant odontogenic tumors. However, β-catenin alterations had not been explored in AOT so far. Further studies are necessary to understand the specific regulation of β-catenin in the AOT pathogenesis.

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^*: ^aProfessor emeritus, Guadalmina Alta, San Pedro de Alcantara, Spain.

^**: ^bAssistant Professor, retired, Department of Restorative Dentistry and Endodontics, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand.

^*: ^cProfessor and Chairman, Department of Oral Surgery and Dental Radiology, Charité, Medical Faculty, Humboldt University, Berlin, Germany.

^**: Reprint requests: Peter A. Reichart, DDS, Dr med dent, Abteilung für Oralchirurgie und Zahnärztliche Röntgenologie, Zentrum für Zahnmedizin, Charité, Medizinische Fakultät der Humboldt Universität, Augustenburger Platz 1, D-13353 Berlin, Germany, [email protected]

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EndodonticsAdenomatoid odontogenic tumor mimicking a periapical (radicular) cyst: A case report*,**,*,**

Abstract

Section snippets

Case report

Discussion

The adenomatoid odontogenic tumour: ameloblastic adenomatoid tumor or adeno-ameloblastoma

Acta Pathol Microbiol Scand

Adenomatoid odontogenic tumour: biological profile based on 499 cases

J Oral Pathol Med

Variants of the adenomatoid odontogenic tumour with a note on tumour origin

J Oral Pathol Med

The adenomatoid odontogenic tumour: ultrastructure of tumour cells and non-calcified amorphous masses

J Oral Pathol Med

The adenomatoid odontogenic tumour (AOT): an update

Oral Med Pathol

Adenomatoid odontogenic tumour: facts and figures

Oral Oncol

Endodontics
Adenomatoid odontogenic tumor mimicking a periapical (radicular) cyst: A case report*,**,*,**