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An Official Publication of the Indian Association of Oral and Maxillofacial Pathologists


 
CASE REPORT Table of Contents   
Year : 2004  |  Volume : 8  |  Issue : 2  |  Page : 104-106
 

Peripheral odonto ameloblastoma


Department of Oral and Maxillo Facial Pathology, M. M College of Dental Sciences and Research, Mullana, Dist. Ambala, India

Correspondence Address:
Sangeeta Palaskar
House No. 49. Sector 1, Jail Land, Ambala City, Ambala
India
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   Abstract 

Odontoameloblastoma is a rare neoplasm of odontogenic origin in which the odontogenic cells have given rise to both an ameloblastoma and a composite odontoma. In this neoplasm, there is proliferation of tissue of the odonlogenic apparatus in an unrestrained pattern including complete morphodifferentiation apposition, and even calcification. The lesion is unusual in that relatively undifferentiated neoplastic tissue is associated with a highly differentiated tissue both of which may show recurrence after inadequate removal.


Keywords: Odontoameloblastoma peripheral odontoameloblastoma, odontogenic apparatus


How to cite this article:
Palaskar S, Nayar AK. Peripheral odonto ameloblastoma. J Oral Maxillofac Pathol 2004;8:104-6

How to cite this URL:
Palaskar S, Nayar AK. Peripheral odonto ameloblastoma. J Oral Maxillofac Pathol [serial online] 2004 [cited 2019 Sep 17];8:104-6. Available from: http://www.jomfp.in/text.asp?2004/8/2/104/40978



   Introduction Top


Odontoameloblastoma is a rare neoplasm of odontogenic origin in which the odontogenic cells have given rise to both an ameloblastoma and a composite odontoma. Thompson et al [1] listed the various synonyms that have been used in literature as ameloblastic odontoma. soft and calcified odontoma. adamantinoma, and calcified mixed odontogenic tumor [2] .

The lesion is unusual in that a relatively undifferentiated neoplastic tissue is associated with a highly diferentiated tissue, both of which may show recurrence after inadequate removal [3] . The incidence of this lesion was 0.5% in a study of 403 odontogenic tumors by Gunhan [4] . Odonoameloblastomas have been reported to be more common in young individuals. with a predilection for the mandible [3] , particularly the premolar-molar region [5] . Symptoms include a slow expansion of the . jaw, dull pain and disturbances in occlusion. Radiographically, the lesion shows destruction of bone, expansion of conical plates. unilocular or multilocular radiolucent area containing dense radio-opacities either as solid masses or as smaller particles, which may or may full bear resemblance to tooth form [3] . In some instances, a single irregular radio-opaque mass of calcified tissue is present. which may be confused with composite odontoma [5] .

The proliferating epithelial portion of the tumor has features of an aneloblastoma, most often of the plexiform or follicular pattern. The ameloblastic component is intermingled with immature or more mature odonlogenic tissue in the form of developing rudimentary teeth, which is similar to the aplearance of a compound odontoma, or conglomerate masses of enamel, dentin, and cementum as seen in a complex odontoma [5] . The following criteria are suggestive for the histologic diagnosis of odontoameloblastoma

a. Unequivocal ameloblastoma

b. Connective tissue with a mature. homogenous appearance

c. Fragments of malformed calcified dental structures [6] .

All reported cases have been central in origin. The present case is probably the first one to have a peripheral Origin


   Case Report Top


The patient, a 42 year old female presented with a complaint of a painless growth in the left retronmolar region The lesion was first noticed 3 years ago. It gradualy increased to the present size, and was static for the past I year. On examination, the lesion was an irregular sessile growth of the same color as the adjacent mucosa. The lesion was firm to palpation measured approx 3 x 3 sq. Cm and was associated with periodontal pockets and mobility in 37, 38. The left submandibular lymph node was palpable. The radiograph (I.O.P.A) showed interdental bone loss with loss of lamina duct in 37, 38 region.

An incisional biopsy from the lesion showed overlying stratified squamous epithelium. and the connective tissue shows ameloblastomatous profileration of cells arranged in a follicular pattern surrounding central stellate reticulum like tissue.

The lesion was subsequently excised and the entire specimen was submitted for hislopathological examination. The excised lesion was a single still tissue specimen, brownish white in color irregular in shape firm in consistency, measuring approx. 4 x 3 x 3 cu. Cm. The cut surface showed an opaque white material to one side of the specimen. A radiograph of the specimen revealed irregular radio-opaque areas within the mass.

The portion of the tissue containing the white material was subjected to a decalcification schedule with 10%. Nitric acid tint period of 24 hours before processing.[Figure 1],[Figure 2],[Figure 3],[Figure 4],[Figure 5]

Microscopically the lesion showed follicular arrangement of ameloblastomatous cells with stellate reticulum In the center. The surrounding connective tissue stroma showed proliferating spindle shaped cells intermingled within which were eosinophilic calcified areas. Around these calcified structures, empty spaces were seen, which could be enamel space, the enamel being lost during the process of decalcification.


   Discussion Top


The odontoameloblastoma is an aggressivc odontogenic neoplasm [7] . with very few cases of this description having been reported in literature. The lesion has caused much confusion and controversy in its nomenclature Earlier, this tumor was confused with ameloblastic libro-odontornas and odontomas. Based on the clinical and histologic behaviour of these lesions, the WHO. has subdivided this category into ameloblastic libro-odontoma and odontoameloblastoma [8] .

All the evidence regarding the origin of ameloblastomas rotates around the derivatives or remnants of the dental lamina. In case of odontoameloblastoma it is only possible to speculate that the odontogenic epithelium may undergo di vergent evolution partly neoplastic to all ameloblastoma and partly to undergo hamartomatous change to an area or odontoma [2] . Since ameloblastomas have been reported to occur peripherally, it is only logical to assume that odontoameloblastomas can also develop in this regon. The interdental bone loss seen between 37 and 38 could be because or infiltration of bone by the lesion. Recurrence of the lesion could not be assessed as the patient did not report for follow-up.

 
   References Top

1.Thompson IOC, Phillips VM, Ferricra R. Housego TG, Odontoameloblasmma: a Case report Br J Oral Maxillolar Surg 28. 1990.347-349  Back to cited text no. 1    
2.Roderick A. Cawson, William H Binnie, Paul Speight, Andrew W'. Barret John M. Wright : Lucas's pathology of Tumors of the Oral tissues. Fifth edition. Churchill Livingstone 1998.  Back to cited text no. 2    
3. . William G Shaferr, Maynard K. Hine, Baract M. Levy : A 'textbook of Oral Pathology. Fourth edition_ W.B. Sounders Company 1997, 31I-312.  Back to cited text no. 3    
4.Gunhan O, Erseven G, Ruacan S et al (1990): Odontogenic tumors: A series of 409 cases. AusirDent J 35.518-522.  Back to cited text no. 4    
5.Brad W. Neville, Douglas D Damm, Carl M. Allen Jerry F. Bouquot : Oral & Maxillolacial Pathology. Second edition. W. B. Saunders Company 2002.630-63 1.  Back to cited text no. 5    
6.Kaugars G E (1991): :Ameloblastic odontoma (Odonlo-ameloblastoma, Oral Surg Oral Med Oral Pathol 71:371-373.   Back to cited text no. 6    
7.Gupta D S. Gupto M K ( 1986): Odontoamcloblastoma, J Oral.Maxillofac .Surg 44: 146-148.  Back to cited text no. 7    
8.Pindborg JJ. K amen IRM. Torlone 11 (1971): Histologic typing or odontogenic tumours. law cysts, and allied lesions. Histological Classification of Tumors No 5, Geneva. World Health Organization.  Back to cited text no. 8    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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    Abstract
    Introduction
    Case Report
    Discussion
    References
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