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 Table of Contents  
CASE REPORT
Year : 2019  |  Volume : 31  |  Issue : 4  |  Page : 374-376

Adenomatoid odontogenic tumor – A diagnostic imaging using cone bean computed tomography


1 Department of Oral Medicine and Radiology, Government Dental College and Hospital, Aurangabad, Maharashtra, India
2 Department of Oral Pathology and Microbiology, Government Dental College and Hospital, Aurangabad, Maharashtra, India

Date of Submission18-Jul-2019
Date of Acceptance30-Dec-2019
Date of Web Publication03-Mar-2020

Correspondence Address:
Dr. Jaishri Pagare
Department of Oral Medicine and Radiology, Government Dental College and Hospital, Aurangabad, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaomr.jiaomr_136_19

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   Abstract 


Adenomatoid odontogenic tumor (AOT) is a rare noninvasive benign tumor of the jaw that originates in the second decade of the life from the odontogenic epithelium without mesenchyme. Radiological examination is an essential component for the diagnosis of benign tumors, the radiographic modality used to acquire the image was speculated to have an effect on the perception of radiopacities, particularly for the cases with minimal intralesional calcifications. Therefore, the capability of radiographic modality in detecting the intralesional calcification was critical for diagnosis of AOT. Cone beam computed tomography (CBCT) provides precise imaging of bony structures with minimal calcification without superimposition and distortion. In this case report, we are reporting a case of AOT of maxilla with characteristic CBCT appearance of AOT of maxilla.

Keywords: Adenomatoid odontogenic tumor, benign tumors of jaw, CBCT appearance, mixed lesion of jaw


How to cite this article:
Pagare J, Johaley S, Bhavthankar J, Mandale M. Adenomatoid odontogenic tumor – A diagnostic imaging using cone bean computed tomography. J Indian Acad Oral Med Radiol 2019;31:374-6

How to cite this URL:
Pagare J, Johaley S, Bhavthankar J, Mandale M. Adenomatoid odontogenic tumor – A diagnostic imaging using cone bean computed tomography. J Indian Acad Oral Med Radiol [serial online] 2019 [cited 2020 Aug 3];31:374-6. Available from: http://www.jiaomr.in/text.asp?2019/31/4/374/279848




   Introduction Top


Adenomatoid odontogenic tumor (AOT) is a slow-growing well-defined tumor which accounts for 3–7% of all odontogenic tumors.[1] It was first discovered by Dreibaldt in 1907 as pseudoadenoameloblastoma and first reported by Hartbitiz (1915) as cystic admantinoma. It is more common in maxilla and commonly associated with an impacted maxillary canine. According to the location and tooth association, AOT is further classified into three categories of follicular, extrafollicular, and peripheral AOT. About 70% of AOTs were recognized as follicular which is associated with an impacted permanent or supernumerary tooth on radiographic images.[2],[3] Although AOT is considered as low occurrence tumor in the literature, Philipsen et al. reported that AOT ranks fourth among the odontogenic tumors. Internal radiopaque foci are considered as one of the significant features of AOT which is can help its differential diagnosis from other bone cystic lesions.

CBCT has been gradually more utilized in displaying the extent, border, surrounding structures, and detailed intralesional calcifications of the lesion in the three-dimensional way particularly when the lesion is overlapped by adjacent bony structures on plain radiographs. In this case report, we focused mainly in CBCT findings of AOT.[4],[5]


   Case Report Top


A 21-year-old male visited the Department of Government Dental College and Hospital Aurangabad with a complaint of painless swelling on right side of the jaw since 8 months. The swelling was small initially and rapidly increased to the current size. There was no history of pain or paresthesia and no difficulty in breathing, eating, or swallowing. The patient's medical and dental history was noncontributory. The patient was moderately built and nourished. The patient's vital signs were normal. On clinical examination, extraoral swelling was noticed on right side of the maxillary jaw extending from right lateral border of nose covering the entire zygomatic region. The swelling was hard in consistency and nontender. Intraorally, the patient had a hard bony swelling extending from 11 to 17 regions more than 7 cm in diameter. The overlying mucosa was normal and there was no sign of any infection the maxillary right lateral incisor was displaced and there was over retained deciduous maxillary canine on right side. There was expansion of the cortex on both the sides. It was provisionally diagnosed as dentigerous cyst associated with impacted maxillary right canine. The differential diagnosis included adenomatoid odontogenic tumor, calcifying odontogenic cyst, ameloblastoma, and central giant cell granuloma.

For understanding the extent of the lesion the patient was scanned using CBCT (9300 CS 3D) imaging system at 90 KVp, 8 mA. Patient consent was taken before undergoing Radiographic examination CBCT revealed a well-defined, unilocular, expansile, mixed, radiolucent–radiopaque lesion with a sclerotic border extending from 12 to 17 regions. Multiple minute variable-shaped radiopaque foci appearing as cluster of small pebbles were seen within the lesion in a circular fashion mainly at the periphery [Figure 1]a [Figure 1]b [Figure 1]c. Root of maxillary right lateral incisor was displaced. There was root resorption with maxillary right first and second premolar [Figure 1]d. The lesion was encircling the impacted maxillary right canine. Deciduous maxillary right canine was overretained [Figure 1]e.
Figure 1: CBCT radiograph showing plenty of calcified spots scattered mainly in the periphery region in all four views Figure 1(a–d). The characteristic feature of calcifications is well displayed on CBCT. The features shown on the panoramic image are relatively doubtful. (a) Coronal plane of CBCT radiograph showing welldefined mixed radiopaque radiolucency in maxillary arch right. Internal structure shows calcification mostly arranged peripheraly. (b) Sagital plane of CBCT radiograph showing well-defined mixed radiopaque radiolucency in maxillary arch. Internal structure shows calcification mostly arranged peripheraly with impacted maxillary canine. (c) Axial plane of CBCT radiograph showing well-defined mixed radiopaque radiolucency in maxillary arch. Internal structure shows calcification mostly arranged peripheraly with impacted maixillary right canine. (d) Showing three-dimensional reconstruction of image. (e) Panoramic radiograph of maxillary arch in CBCT

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The lesion was completely enucleated. On gross examination, it appeared as a soft, roughly spherical mass with a distinct fibrous capsule. Cut section revealed cystic spaces of varying sizes with semisolid material and yellowish brown fluid. Calcified masses were present throughout the tumor mass. It also showed embedded tooth in the solid tumor mass.

Microscopically H and E stained section exhibits follicular connective tissue. Areas of cuboidal to columnar cells in the form of rosettes and nests are evident solid areas duct-like pattern, whorled arrangement of cells and tubular appearance is evident. Presence of thin anastomosing strands of basaloid cells arranged in a plexiform pattern. Eosinophilic fibrillar material is present between tumor cells and within duct-like structure [Figure 2].
Figure 2: (a) Duct-like appearance of adenomatoid odontogenic tumors and nominal calcifications in the duct-like spaces; (b) characteristic rosette-like structures; whereas (c) and (d) demonstrate widespread calcifications in the lesion

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   Discussion Top


In this study, we evaluated the clinical and CBCT appearance of AOT of maxilla. We mainly highlighted the diagnostic significance of CBCT in presenting the characteristic features of AOT. The radiological differential diagnosis of AOT from a variety of odontogenic lesions is of great clinical importance. The radiographic modality used to obtain the image was speculated to have an effect on the sensitivity of radiopacities, mainly for the cases with minimal intralesional calcifications. Therefore, the capability of radiographic modality in detecting the intralesional calcifications was critical for the diagnosis of AOT.[6],[7],[8],[9],[10],[11]

CBCT has been progressively used in the fields of oral maxillofacial surgery, implantology, orthodontics, and endodontics. CBCT is beneficial in demonstrating the extent, border, surrounding structures, and detailed intralesion content (i.e. calcifications) of lesions in a three-dimensional way, mainly when the lesion is overlapped by adjacent bony structures on plain radiographs.[12] As an advanced imaging modality, CBCT has been commonly applied to different fields of dentistry and oral maxillofacial surgery.[13] The main benefit of CBCT radiography is the multiplanar cross-sectional images in several orientations and three-dimensional reconstructions based on a single scan of fields of view of interest, varying from a single tooth to the whole maxillofacial area. CBCT imaging is superior to panoramic radiography with regard to exclusion of superimposition and better contrast resolution for mineralized tissue such as teeth, bones and calcified spots. Therefore, CBCT is beneficial in terms of representing the detailed internal structures of lesions (e.g. radiopaque calcified deposits), mostly when the calcifications are slight or the superimposition is severe in the maxillary region. Moreover, CBCT delivers better display of the extent and complex spatial relationship of the lesions with the surrounding structures.

Though CBCT valuation due to its ability to delivers more information from the internal structure of the lesion suggests the differential diagnosis of AOT. Intralesional calcification with characteristic pattern was suggested as a typical radiographic feature of AOT. Therefore, the ability to recognize characteristic calcification on radiographs even in minor amounts is extremely meaningful for diagnosis.


   Conclusion Top


CBCT clearly displays adenomatoid odontogenic tumor lesions in three-dimensional perspectives. The distinctive internal calcification features, shape of tumors, thorough relationship between surrounding structures and associated impacted tooth are well revealed on CBCT. The distribution pattern of radiopaque calcified deposits shown on CBCT images is important for radiographic diagnosis of adenomatoid odontogenic tumor.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Neville BW, Damn DD, Allen CM, Bouquot JE. Oral and Maxillofacial Pathology. 2nd ed. Philadelphia, WB Saunders; 2002. p. 541-93.  Back to cited text no. 1
    
2.
Philipsen HP, Reichart PA. Adenomatoid odontogenic tumour: Facts and figures. Oral Oncol 1999;35:125-31.  Back to cited text no. 2
    
3.
Rick GM. Adenomatoid odontogenic tumor. Oral Maxillofac Surg Clin North Am 2004;16:333-54.  Back to cited text no. 3
    
4.
Jiang M, You M, Wang H, Xu L. Characteristic features of the adenomatoid odontogenic tumour on cone beam CT. Dentomaxillofac Radiol 2014;43:20140016.  Back to cited text no. 4
    
5.
Philipsen HP, Reichart PA, Siar CH, Ng KH, Lau SH, Zhang X, et al. An updated clinical and epidemiological profile of the adenomatoid odontogenic tumour: A collaborative retrospective study. J Oral Pathol Med 2007;36:383-93.  Back to cited text no. 5
    
6.
Philipsen HP, Reichart PA, Siar CH, Ng KH, Lau SH, Zhang X, et al. An updated clinical and epidemiological profile of the adenomatoid odontogenic tumour: A collaborative retrospective study. J Oral Pathol Med 2007;36:383-93.  Back to cited text no. 6
    
7.
Chindasombatjaroen J, Poomsawat S, Kakimoto N, Shimamoto H. Calcifying cystic odontogenic tumor and adenomatoid odontogenic tumor: Radiographic evaluation. Oral Surg Oral Med Oral Pathol Oral Radiol 2012;114:796-803.  Back to cited text no. 7
    
8.
Philipsen HP, Birn H. The adenomatoid odontogenic tumour. Ameloblastic adenomatoid tumour or adeno-ameloblastoma. Acta Pathol Microbiol Scand 1969;75:375-98.  Back to cited text no. 8
    
9.
Arotiba GT, Arotiba JT, Olaitan AA, Ajayi OF. The adenomatoid odontogenic tumor: An analysis of 57 cases in a black African population. J Oral Maxillofac Surg 1997;55:146-8; discussion 149-50.  Back to cited text no. 9
    
10.
Mohamed A, Singh AS, Raubenheimer EJ, Bouckaert MM. Adenomatoid odontogenic tumour: Review of the literature and an analysis of 33 cases from South Africa. Int J Oral Maxillofac Surg 2010;39:843-6.  Back to cited text no. 10
    
11.
Dare A, Yamaguchi A, Yoshiki S, Okano T. Limitation of panoramic radiography in diagnosing adenomatoid odontogenic tumors. Oral Surg Oral Med Oral Pathol 1994;77:662-8.  Back to cited text no. 11
    
12.
De Vos W, Casselman J, Swennen GR. Cone-beam computerized tomography (CBCT) imaging of the oral and maxillofacial region: A systematic review of the literature. Int J Oral Maxillofac Surg 2009;38:609-25.  Back to cited text no. 12
    
13.
Ahmad M, Jenny J, Downie M. Application of cone beam computed tomography in oral and maxillofacial surgery. Aust Dent J 2012;57(Suppl 1):82-94.  Back to cited text no. 13
    


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