BRIAN L.

EVANS et al Oral surg Oral med Oral pathol Oral radio Endo,2004; 98: 583-588

 Adenoid

ameloblastoma with dentinoid can be considered a variant of amreloblastoma It has histologic features of both ameloblastoma and adenomatoid odontogenic tumor(AOT),including calcified tissue AOTs are uncommon benign odontogenic lesions characterized by duct like structures that form from the epithelial component of the lesion

develop in females during the second or third decade of life Often associated with embedded teeth and often in the anterior maxilla. When mandibular they are likewise typically in the anterior region Ameloblastomas arise from odontogenic epithelium and are commonly cystic They are locally invasive but follow a benign course in the majority of cases excluding the odontoameloblastoma, they generally do not show induction of dental hard tissue
Most

 In

dec 1981, a 35 yr old white male came to an oral and maxillofacial surgeon complaining of painful erupted maxillary and mandibular third molar teeth. In jan 1986 the patient now 39 yrs old was referred to the same surgeon for evalution of a radiolucent area in the anterior mandible involving all 4 incisors and the right cuspid and right first premolar teeth Two weeks later a needle biopsy of the lesion was performed yielding straw- colored fluid

A week after the needle biopsy a large cystic appearing lesion was removed which was found to involve also the mandibular right second premolar tooth In nov 1987 during routine followup periapical and panoramic radiographs revealed buccal expansion of cystic area confirmed by radiographs in march of 1988. the lesion at that time was similar in size to the 1986 Lesion was surically treated with mechanical curretage which included apicocetomies and retrograde amalgam filling performed on the right lateral incisor, cuspid and first premolar teeth Pathologist reported the lesion to be recurrent adenomatoid odontogenic tumor

1996 the patient was presented radiographs again showed abnormal radioleucemcy of the anterior mandible through smaller than before Right lateral incisor, cuspid and first premolar were extracted to facilitate curettage, and enucleated tissue from the area was again reported as reccurent adenomatoid odontogenic tumor.
Jan

periapical radiograph demonstrated a radioleucent lesion of the anterior mandible with cortical invasion The lesion was enucleated and diagnosed as ameloblastoma with features of adenomatoid odontogenic tumor Following discussion with the patient a larger resection was performed in june 2002. The patient continued on a 18 month follow up schedule and at 18 months has no signs or symptoms indicative of recurrence.

 Lesional

tissue from 1986( initial biosy), 1996( second recurrence) and 2002( third reccurence) was viewed H&E stained microslides showed a tumor with basoloid epithelium along with fibrocellular connective tissue There were duct like structures of palisaded columnar epithelial cells and pink to reddish extracellular material Occasionaly epithelial whorls displayed squamous differentiation with or without cystic change within the squamous area

 The

second recurrence in 1996 seemingly exhibited more ameloblastic characteristics including columanar cells polarized nuclei next to tissue with features of stellate reticulum observed in the peripheral, capsular region of the tumor There were relatively fewer epithelial cells and more matrix material with chondroid appearance. Several tumor cells had clear cytoplasm

 In

this case when tissue from the initial lesion and 2 of the recurrences was ultimately reviewed, histologic features described in cases reported as ameloblastoma with dentinoid induction Clear cells evident in 2002 recurrence of our tumor have been found in a number of jaw tumors including calcifying epithelial odontogenic tumor(CEOT) and ameloblastomas

The presence of AOT like tissue has modified the names of various odontogenic tumors including adenomatoid dentinoma. Adenoameloblastic odontoma and adenoid ameloblastoma with dentinoid Larsson et al reported a case of multiple jaw lesions all having separate features of AOT and adenomatoid dentinoma . Combination of AOT with calcifying odontogenic cysts(COC) has also been observed and reported Microscopic changes resembling an AOT have been observed in association with 2 unicystic ameloblastomas.

 Because

the AOT is an entity that is long known and well described, the likelihood of mistaking it for ameloblastoma, which it resembles is presumably less. The present case demonstrates an instance in which the converse situation occurred: that is an ameloblastoma with adenoid features was mistaken for an AOT It mirrors the case in which pathologists at the Armed Forces Institute Of Pathology(AFIP) diagnosed a tumor as ameloblastoma with dentinoid

 When

AFIP case was included in 1994 diagnostic exercise, 44% of 105 participants provided a diagnosis of AOT while 41% preferred an interpretation of ameloblastoma Behaviour of the lesion in this case has been typical of an ameloblastoma with local recurrences following subtotal removal of tumor

Histological features of the lesion indicative of ameloblastoma included polarization of nuclei of columnar cells,some with subnuclear clear cytoplasms adjacent to tissue resembling stellate reticulum There were also occasional areas of squamous differentiation and microcystic change within the stellate reticulum like tissue Lack of eosinophillic extracellular material often associated with small whorls in AOT