Abstract
A 33-year-old lady presented to her dentist with loose teeth and a 15×14 mm cavitating defect on the palatal mucosa adjacent to the teeth 22 and 23. Radiology showed a well demarcated radiolucent lesion with erosion of the roots of adjacent teeth. An initial biopsy showed features of odontogenic fibroma. Local excision confirmed a central odontogenic fibroma (COF). Light microscopy and immunohistochemistry of both specimens showed features of COF comprised of dense fibromyxoid stromal tissue with scattered bland epithelial nests which were immunoreactive for CK14, AE1/AE3, CK5/6, CK19 and 34βE12. S100 and CDla positive, CD68 negative Langerhans cells (LCs) were seen within epithelial islands. COF accounts for 0.1% of all odontogenic tumours. Researchers are uncertain whether it is a reactive process (hamartoma) or a neoplasm. It is diagnosed most frequently in patients between the second and fourth decades, and occurs with equal incidence in maxilla and mandible. A relationship between LCs and lower stage/prognosis has been published in a number of different tumours, raising the question of whether LCs have a role in the immunosurveillance against cancer. The pathological significance of LCs in COF is still unclear but perhaps they could have a role in local growth patterns.
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