Journal of Indian Academy of Oral Medicine and Radiology

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

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


Jaishri Pagare1, Satyapal Johaley1, Jyoti Bhavthankar2, Mandakini Mandale2,  
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

Correspondence Address:
Dr. Jaishri Pagare
Department of Oral Medicine and Radiology, Government Dental College and Hospital, Aurangabad, Maharashtra
India

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.



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;31:374-376


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 Jun 4 ];31:374-376
Available from: http://www.jiaomr.in/text.asp?2019/31/4/374/279848


Full Text



 Introduction



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



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}

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}

 Discussion



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



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.

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