Another identifying feature is the presence of duct-like structures (Figure 8).Small calcifications may be found in the tumor. If they are present in sufficient size and number, theymay show on the radiograph as a “snow-flake” pat-tern. A homogeneous, eosinophilic and amorphousmaterial may occasionally be found in AOT. Its identi-ty is disputed. Some consider it a peculiar form of enamel matrix, others claim that it is a dentin-likematerial. This is of no clinical importance but doesraise questions if this is a pure epithelial tumor (enam-el matrix) or has an ectomesenchymal component(dentin matrix).
CALCIFYING EPITHELIAL ODONTOGENIC TUMOR (CEOT, Pindborg tumor)
This tumor is so rare that it deserves little discus-sion. In 1958, Dr. J.J. Pindborg of Denmark describedfour cases of an unusual odontogenic tumor that stillbears his name. This is the most “unodontogenic”tumor of the group, the tumor cells do not resembleodontogenic tissue. Tumor cells are squamous-like,they even have desmosomal attachments. There oftenis variation in nuclear size, shape and staining intensi-ty—features that are often associated with malignancy(Figure 10). This tumor forms an amorphous materialthat is said to be amyloid or amyloid-like (Figure 11).Whatever it is, it calcifies in a concentrically lamellat-ed “tree-ring” pattern known as Liesegang calcifica-tions. This explains the name of calcifying epithelialodontogenic tumor.CEOT lacks a capsule but apparently does not infil-trate as deeply into surrounding tissues as doesameloblastoma. Excision with a small margin of sur-rounding bone is usually curative.Radiographically, this tumor may appear as a radi-olucent tumor but if sufficient calcifications are pres-ent, it becomes dense (Figure 9).NOTE: We have skipped malignant ameloblas-toma, ameloblastic carcinoma, clear cell odontogeniccarcinoma and odontoameloblastoma and squamousodontogenic tumors because they are too rare. Theyare covered in your text.
This is a tumor of childhood, the typical patient isabout 12 –14 years old, seldom is it seen beyond age20. The posterior segment of the mandible is the mostcommon location. Local swelling or failure of teeth toerupt on time or in proper alignment may call atten-tion to the tumor. Ameloblastic fibromas are purelyradiolucent.
Calcifications(extreme left) in a CEOTaccount for the densitynoted on radiographs.These are thought to becalcified amyloid oramyloid-like material,some of which can beseen right of center as apale eosinophilic globule(arrow).
CEOT, highpower view. The tumorcells resemble squamousepithelium more thanodontogenic epithelium.There is some variationin nuclear size andshape, but this is not amalignant tumor.
Calcifying epithe-lial odontogenic tumor inthe body of themandible. It appears asa radiolucent lesion withsmokey dense areas.
Adenomatoidodontogenic tumor. Notethe duct-like structures(see arrow)
Ameloblasticfibroma in and aroundthe crowns of lowermolar teeth. It is subtle,the second deciduousmolar tooth has been tilt-ed downward by thetumor. Patient was a 5year old boy.