adenoma odontogenic tumor /dental courses

ADENOMATOID ODONTOGENIC
TUMOR
--- A CASE REPORT ---
www.indiandentalacademy.com

INTRODUCTION
Adenomatoid odontogenic tumor (AOT) is a
benign (hamartomatous), non-invasive lesion
with slow but progressive growth.
AOT commonly occurs in association with
the crowns of unerupted teeth, maxillary
canine being the most common (follicular),
however may also occur without the
presence of any impacted tooth
(extrafollicular type).

AOT is believed to arise from the remnants
of the dental lamina which give rise to
epithelial rests that proliferate in response
to an unknown stimulus and characterized
histologically by anastomosing cords or
strands of epithelium.

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CHIEFCHIEF COMPLAINTCOMPLAINT

• PAST DENTAL HISTORYPAST DENTAL HISTORY
MEDICAL HISTORYMEDICAL HISTORY
• FAMILY HISTORYFAMILY HISTORY

GENERAL PHYSICALGENERAL PHYSICAL
EXAMINATIONEXAMINATION

• Facial symmetryFacial symmetry
• TMJ examinationTMJ examination
• Lymph nodesLymph nodes
• Salivary glandsSalivary glands
EXTRA – ORAL EXAMINATIONEXTRA – ORAL EXAMINATION

SOFT TISSUESOFT TISSUE
INTRA – ORAL EXAMINATIONINTRA – ORAL EXAMINATION

HARD TISSUEHARD TISSUE

EXTRA ORALEXTRA ORAL
EXAMINATION OFEXAMINATION OF
THE LESIONTHE LESION

INTRA ORAL EXAMINATIONINTRA ORAL EXAMINATION

PROVISIONAL DIAGNOSISPROVISIONAL DIAGNOSIS
• Benign odontogenic tumor of the rightBenign odontogenic tumor of the right
side of the mandible.side of the mandible.
DIFFERENTIAL DIAGNOSISDIFFERENTIAL DIAGNOSIS
AmeloblastomaAmeloblastoma
Adenomatoid odontogenic tumorAdenomatoid odontogenic tumor
Calcifying epithelial odontogenic tumorCalcifying epithelial odontogenic tumor
Calcifying epithelial odontogenic cystCalcifying epithelial odontogenic cyst
Central giant cell granulomaCentral giant cell granuloma

1.PULP VITALITY TEST:1.PULP VITALITY TEST:
31, 41, 42, 43, 44, 45 responded31, 41, 42, 43, 44, 45 responded
to the electric pulp vitality test.to the electric pulp vitality test.
INVESTIGATIONSINVESTIGATIONS

2.HEMATOLOGICAL2.HEMATOLOGICAL
ESR-ESR- 44mm44mm

3.RADIOLOGICAL EXAMINATION3.RADIOLOGICAL EXAMINATION
IOPAIOPA
41,42,43,44,4541,42,43,44,45

CROSS SECTIONAL MANDIBULARCROSS SECTIONAL MANDIBULAR
OCCLUSAL VIEWOCCLUSAL VIEW

PANORAMIC RADIOGRAPHPANORAMIC RADIOGRAPH

• CT SCANCT SCAN

FNACFNAC
• Smear from the centrifuged depositSmear from the centrifuged deposit
showed low cellularity. Lymphocytes, fewshowed low cellularity. Lymphocytes, few
histiocytes and neutrophils were seen.histiocytes and neutrophils were seen.
• No malignant cells were seen in the smearNo malignant cells were seen in the smear
examined.examined.

• INCISIONAL BIOPSYINCISIONAL BIOPSY

HISTOPATHOLOGICAL EXAMINATIONHISTOPATHOLOGICAL EXAMINATION
Section shows tumorSection shows tumor
comprising of nestcomprising of nest
and duct likeand duct like
structures lined bystructures lined by
low columnarlow columnar
epithelial cells withepithelial cells with
benign looking nuclei.benign looking nuclei.
Stroma comprises ofStroma comprises of
spindle shaped cells.spindle shaped cells.
Foci of calcificationFoci of calcification
and areas ofand areas of
hemorrhage werehemorrhage were
seen.seen. www.indiandentalacademy.com

• FINAL DIAGNOSISFINAL DIAGNOSIS
ADENOMATOID ODONTOGENIC TUMORADENOMATOID ODONTOGENIC TUMOR
OF THE MANDIBLEOF THE MANDIBLE
IN RELATION TO 42, 43, 44.IN RELATION TO 42, 43, 44.

DISCUSSIONDISCUSSION

• Adenomatoid odontogenic tumor (AOT) is aAdenomatoid odontogenic tumor (AOT) is a
rare benign tumor that accounts for aboutrare benign tumor that accounts for about
3% of all odontogenic tumors.3% of all odontogenic tumors.
• AOT was first reported by Harbitz inAOT was first reported by Harbitz in
1915 under the name of cystic1915 under the name of cystic
adamantoma.adamantoma.

• Philipsen and Birn proposed the widelyPhilipsen and Birn proposed the widely
accepted and currently used nameaccepted and currently used name
adenomatoid odontogenic tumor, that wasadenomatoid odontogenic tumor, that was
first adopted by the first edition of WHOfirst adopted by the first edition of WHO
classification of odontogenic tumors inclassification of odontogenic tumors in
1971.1971.

• AOT is defined as a tumor composed ofAOT is defined as a tumor composed of
odontogenic epithelium in a variety ofodontogenic epithelium in a variety of
histoarchitectural patterns, embedded inhistoarchitectural patterns, embedded in
a mature connective tissue stroma, anda mature connective tissue stroma, and
characterized by a slow but progressivecharacterized by a slow but progressive
growth.growth.

• AOT is most commonly seen in the youngAOT is most commonly seen in the young
patients, especially in the second decadepatients, especially in the second decade
of life, and is uncommon in patients olderof life, and is uncommon in patients older
than 30 years of age.than 30 years of age.
• Females are affected, more than theFemales are affected, more than the
males.males.
• Maxilla is affected twice as frequently asMaxilla is affected twice as frequently as
the mandible and the anterior part of thethe mandible and the anterior part of the
jaw is affected more frequently than thejaw is affected more frequently than the
posterior part.posterior part.

• An unerupted tooth is most commonlyAn unerupted tooth is most commonly
associated with AOT (74%), but mayassociated with AOT (74%), but may
also occur without the presence of anyalso occur without the presence of any
impacted tooth as seen in my case.impacted tooth as seen in my case.

• Clinically, AOT presents as a slow growingClinically, AOT presents as a slow growing
symptom free lesion and is frequentlysymptom free lesion and is frequently
discovered during a routine radiographicdiscovered during a routine radiographic
examination.examination.

• AOT can occur both intraosseouslyAOT can occur both intraosseously
(97%) and extraosseously.(97%) and extraosseously.
• The intraosseous type can be dividedThe intraosseous type can be divided
radiographically into two types:radiographically into two types:
i) Follicular (pericoronal) (73%)i) Follicular (pericoronal) (73%)
ii) Extrafollicular (extracoronal)ii) Extrafollicular (extracoronal)
(27%)(27%)

• The extraosseous type of AOT areThe extraosseous type of AOT are
rarely detected radiographically, butrarely detected radiographically, but
there may be slight erosion of thethere may be slight erosion of the
underlying alveolar bone cortex.underlying alveolar bone cortex.

• The most common clinical presentation isThe most common clinical presentation is
slow growing swelling with a few havingslow growing swelling with a few having
mild pain which corresponds with themild pain which corresponds with the
behavior of AOT i.e. slow growing lesionbehavior of AOT i.e. slow growing lesion
that rarely causes pain.that rarely causes pain.

• This tumor appears to arise from theThis tumor appears to arise from the
remnants of the dental lamina, which giveremnants of the dental lamina, which give
rise to epithelial rests that proliferate inrise to epithelial rests that proliferate in
response to an unknown stimulus.response to an unknown stimulus.

• The development of the extra follicularThe development of the extra follicular
AOT may occur when the epithelial restsAOT may occur when the epithelial rests
are located at the periphery of the pathare located at the periphery of the path
of eruption. The tooth therefore wouldof eruption. The tooth therefore would
not be impeded in its eruption by thenot be impeded in its eruption by the
developing tumor.developing tumor.

• Radiographically, AOT may appear asRadiographically, AOT may appear as
a well defined, round or oval uniloculara well defined, round or oval unilocular
radiolucent area with a distinctradiolucent area with a distinct
radiopaque border which is the typicalradiopaque border which is the typical
radiographic manifestation of AOT.radiographic manifestation of AOT.

• AOT is usually surrounded by a wellAOT is usually surrounded by a well
developed connective tissue capsule withdeveloped connective tissue capsule with
spindle shaped or polygonal cells formingspindle shaped or polygonal cells forming
sheets and whirled masses in a scantysheets and whirled masses in a scanty
connective tissue stroma.connective tissue stroma.

• Anastomosing cords or strands ofAnastomosing cords or strands of
epithelium that are 1 to 2 cells thick areepithelium that are 1 to 2 cells thick are
seen at the periphery of some tumorsseen at the periphery of some tumors
which are lined by a single row ofwhich are lined by a single row of
columnar epithelial cells, the nuclei ofcolumnar epithelial cells, the nuclei of
which are polarized away from the centralwhich are polarized away from the central
lumen. Dystrophic calcifications can belumen. Dystrophic calcifications can be
seen in most of the AOTs within theseen in most of the AOTs within the
lumen of duct like structures.lumen of duct like structures.

• The treatment of choice for AOT isThe treatment of choice for AOT is
surgical enucleation with no recurrencessurgical enucleation with no recurrences
being reported.being reported.

CONCLUSIONCONCLUSION

• Although AOT are seen most commonlyAlthough AOT are seen most commonly
in the anterior part of the maxilla within the anterior part of the maxilla with
a history of impacted teeth, it may alsoa history of impacted teeth, it may also
occur in the mandible with no history ofoccur in the mandible with no history of
unerupted teeth.unerupted teeth.
• Secondly, the diagnosis of AOT shouldSecondly, the diagnosis of AOT should
be considered when the clinician isbe considered when the clinician is
presented with a corticated radiolucencypresented with a corticated radiolucency
in the anterior jaws especially in teensin the anterior jaws especially in teens
and young adults.and young adults.

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